Provider Demographics
NPI:1376672337
Name:KERRIGAN, KAREN HARTELY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:HARTELY
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:NP
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 1060
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-1060
Mailing Address - Country:US
Mailing Address - Phone:318-283-3600
Mailing Address - Fax:
Practice Address - Street 1:323 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4521
Practice Address - Country:US
Practice Address - Phone:318-283-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81902-03958363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1128210Medicaid