Provider Demographics
NPI:1467189258
Name:KERVIN, SUMMER ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:ELIZABETH
Last Name:KERVIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 WAXMYRTLE WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9478
Mailing Address - Country:US
Mailing Address - Phone:334-945-0105
Mailing Address - Fax:
Practice Address - Street 1:100 JIM MASON CT STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8965
Practice Address - Country:US
Practice Address - Phone:478-474-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN314188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily