Provider Demographics
NPI:1245681378
Name:KERKER, TONYA MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MARIE
Last Name:KERKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3358
Mailing Address - Country:US
Mailing Address - Phone:563-676-2858
Mailing Address - Fax:
Practice Address - Street 1:1518 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3433
Practice Address - Country:US
Practice Address - Phone:563-264-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant