Provider Demographics
NPI:1194019794
Name:KERR, KATIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:BOURQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8383 MILLICENT WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-5207
Mailing Address - Country:US
Mailing Address - Phone:318-797-6661
Mailing Address - Fax:318-795-8512
Practice Address - Street 1:8383 MILLICENT WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-5207
Practice Address - Country:US
Practice Address - Phone:318-797-6661
Practice Address - Fax:318-795-8512
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-059895207Q00000X
LA206909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine