Provider Demographics
NPI:1114210374
Name:HERSHBERGER, KERI LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:LYNN
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HEALTHY PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062
Mailing Address - Country:US
Mailing Address - Phone:220-564-1915
Mailing Address - Fax:220-564-1916
Practice Address - Street 1:ONE HEALTHY PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062
Practice Address - Country:US
Practice Address - Phone:220-564-1915
Practice Address - Fax:220-564-1916
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60521862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164976Medicaid
OHH294600Medicare PIN