Provider Demographics
NPI:1114608130
Name:KERR, JOLIE
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15682
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80935-5682
Mailing Address - Country:US
Mailing Address - Phone:719-963-6299
Mailing Address - Fax:
Practice Address - Street 1:2886 S CIRCLE DR # 2232
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4111
Practice Address - Country:US
Practice Address - Phone:719-963-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172A00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver