Provider Demographics
NPI:1164778171
Name:CHRISTY, KERRY DOYLE (CPNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DOYLE
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:E
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:PEDIATRIC SURGERY OFFICE 122 MAILSTOP 6015
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-3015
Mailing Address - Fax:216-844-8687
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:PEDIATRIC SURGERY OFFICE 122 MAILSTOP 6015
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3015
Practice Address - Fax:216-844-8687
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20121452363LP0200X
OHCTP:13684363LP0222X
OH20121612363LP0222X
OHCOA.13684-NP363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics