Provider Demographics
NPI:1144452160
Name:ERLING, KERRY (PA)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:ERLING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:KELLEHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:41715 WINCHESTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4808
Mailing Address - Country:US
Mailing Address - Phone:951-308-4451
Mailing Address - Fax:
Practice Address - Street 1:41715 WINCHESTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4808
Practice Address - Country:US
Practice Address - Phone:951-308-4451
Practice Address - Fax:951-506-0992
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15665363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical