Provider Demographics
NPI:1003693201
Name:AHEARN, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:AHEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 GOLDEN RAIN RD APT 5
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1946
Mailing Address - Country:US
Mailing Address - Phone:925-917-3474
Mailing Address - Fax:
Practice Address - Street 1:1350 ARNOLD DR STE 102
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4190
Practice Address - Country:US
Practice Address - Phone:844-844-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker