Provider Demographics
NPI:1346254679
Name:KERR, ELIZABETH C (MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:KERR
Suffix:
Gender:F
Credentials:MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 741593
Mailing Address - Street 2:CHILDRENS SURGICAL SPECIALTY GROUP INC
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374
Mailing Address - Country:US
Mailing Address - Phone:757-668-7878
Mailing Address - Fax:757-668-7883
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7878
Practice Address - Fax:757-668-7883
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000209363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
311610834OtherTRICARE
VA52444NOtherOPTIMA/SENTARA HEALTH
VA7792433Medicaid
VA500001048Medicare ID - Type Unspecified