Provider Demographics
NPI:1114303559
Name:KERBY, CARRIE ANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANNE
Last Name:KERBY
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 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICE
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-935-5331
Mailing Address - Fax:
Practice Address - Street 1:550 HALLMARK DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8648
Practice Address - Country:US
Practice Address - Phone:937-456-4181
Practice Address - Fax:937-456-4649
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007000A363LF0000X
OHAPRN.CNP.17936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000951992OtherANTHEM
OH0141383Medicaid
OHH3933010Medicare PIN