Provider Demographics
NPI:1760473805
Name:PADILLA, KERRIE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:LYNN
Last Name:PADILLA
Suffix:
Gender:
Credentials:OD
Other - Prefix:MISS
Other - First Name:KERRIE
Other - Middle Name:LYNN
Other - Last Name:BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE STOP A
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-8952
Mailing Address - Country:US
Mailing Address - Phone:910-907-9597
Mailing Address - Fax:910-396-8755
Practice Address - Street 1:2817 ROCK MERRITT AVE STOP A
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2398152W00000X
MO2003018486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist