Provider Demographics
NPI:1376514760
Name:STILLWELL, KERRI F (PA-C)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:F
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-0912
Mailing Address - Country:US
Mailing Address - Phone:540-463-2103
Mailing Address - Fax:540-463-2904
Practice Address - Street 1:110 HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-0912
Practice Address - Country:US
Practice Address - Phone:540-463-2103
Practice Address - Fax:540-463-2904
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001505363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013897L12Medicare PIN