Provider Demographics
NPI:1144640012
Name:DUPRE, KERRI (ATC, AEMT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:DUPRE
Suffix:
Gender:F
Credentials:ATC, AEMT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:VENTRESCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1285 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5237
Practice Address - Country:US
Practice Address - Phone:617-751-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4092255A2300X
MAPA100303363A00000X
ME26731146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate