Provider Demographics
NPI:1144535840
Name:AMERSON, KERI L
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:AMERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 N VALDOSTA RD STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1685
Mailing Address - Country:US
Mailing Address - Phone:229-242-9310
Mailing Address - Fax:229-242-9714
Practice Address - Street 1:3321 N VALDOSTA RD STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1685
Practice Address - Country:US
Practice Address - Phone:229-242-9310
Practice Address - Fax:229-242-9714
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 141829363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG62066Medicare UPIN