Provider Demographics
NPI:1114484565
Name:MORSE, KERRY (LPN)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MORSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:147 NORTH WAY
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:147 NORTH WAY
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1253
Practice Address - Country:US
Practice Address - Phone:315-708-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130899-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse