Provider Demographics
NPI:1093771701
Name:LAST, KERRI LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LEE
Last Name:LAST
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 STATE ROUTE 257
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346
Mailing Address - Country:US
Mailing Address - Phone:814-677-2262
Mailing Address - Fax:814-677-2279
Practice Address - Street 1:3512 STATE ROUTE 257
Practice Address - Street 2:SUITE 108
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-677-2262
Practice Address - Fax:814-677-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006749B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner