Provider Demographics
NPI:1396836698
Name:BURLEW, KERRI A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:A
Last Name:BURLEW
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 1:500 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8064
Mailing Address - Country:US
Mailing Address - Phone:732-914-2233
Mailing Address - Fax:
Practice Address - Street 1:500 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8064
Practice Address - Country:US
Practice Address - Phone:732-914-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP0009530363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00250958OtherRAILROAD MEDICARE
NJ080508NAFMedicare ID - Type Unspecified
NJP77989Medicare UPIN