Provider Demographics
NPI:1013541499
Name:LEICH, KERRI LYNN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:LYNN
Last Name:LEICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 PEG LEG CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1848
Mailing Address - Country:US
Mailing Address - Phone:248-613-8841
Mailing Address - Fax:
Practice Address - Street 1:751 E 9 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1989
Practice Address - Country:US
Practice Address - Phone:248-677-2273
Practice Address - Fax:248-291-6731
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470297459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily