Provider Demographics
NPI:1144800251
Name:KERR, KATIE (FNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N 2ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-1021
Mailing Address - Country:US
Mailing Address - Phone:662-480-4141
Mailing Address - Fax:
Practice Address - Street 1:1115 N 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-1021
Practice Address - Country:US
Practice Address - Phone:662-480-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144800251OtherNPI