Provider Demographics
NPI:1043607575
Name:CHAMPNESS, KERRI- ANN
Entity Type:Individual
Prefix:
First Name:KERRI- ANN
Middle Name:
Last Name:CHAMPNESS
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 1:51 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4165
Mailing Address - Country:US
Mailing Address - Phone:631-905-3741
Mailing Address - Fax:631-392-0084
Practice Address - Street 1:51 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4165
Practice Address - Country:US
Practice Address - Phone:631-905-3741
Practice Address - Fax:631-392-0084
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator