Provider Demographics
NPI:1073174918
Name:KERR, KEITH LAVELLE JR
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:LAVELLE
Last Name:KERR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-2526
Mailing Address - Country:US
Mailing Address - Phone:913-766-1027
Mailing Address - Fax:
Practice Address - Street 1:2914 N 38TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-2526
Practice Address - Country:US
Practice Address - Phone:913-766-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities