Provider Demographics
NPI:1649562950
Name:CREASY, KERRY RAE (PHD, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:RAE
Last Name:CREASY
Suffix:
Gender:F
Credentials:PHD, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 VERMONT AVE NW RM 4050
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20571-0001
Mailing Address - Country:US
Mailing Address - Phone:202-805-6956
Mailing Address - Fax:
Practice Address - Street 1:811 VERMONT AVE NW RM 4050
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20571-0001
Practice Address - Country:US
Practice Address - Phone:202-805-6956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9281775363LP0808X
VA0001340376163W00000X
VA0024194634363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse