Provider Demographics
NPI:1144221318
Name:KERR, ALICE (ARNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8101 BIRCHWOOD CT
Mailing Address - Street 2:SUITE S
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2930
Mailing Address - Country:US
Mailing Address - Phone:515-471-9720
Mailing Address - Fax:515-471-9725
Practice Address - Street 1:1205 COPPER CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7002
Practice Address - Country:US
Practice Address - Phone:515-266-1199
Practice Address - Fax:515-266-0615
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0000000000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA719260412Medicare PIN