Provider Demographics
NPI:1255849071
Name:BARONE, KERRI LYNNE
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNNE
Last Name:BARONE
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 1:123 TRUXTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2460
Mailing Address - Country:US
Mailing Address - Phone:850-863-1530
Mailing Address - Fax:850-862-4589
Practice Address - Street 1:341 HOLMES BLVD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4150
Practice Address - Country:US
Practice Address - Phone:850-301-0635
Practice Address - Fax:850-301-0653
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811318100Medicaid