Provider Demographics
NPI:1477500676
Name:KOKAISEL, KERRY L (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:L
Last Name:KOKAISEL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 STATE HWY 50 W
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773
Mailing Address - Country:US
Mailing Address - Phone:662-524-4347
Mailing Address - Fax:662-524-4364
Practice Address - Street 1:217 COURT ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2926
Practice Address - Country:US
Practice Address - Phone:662-494-7060
Practice Address - Fax:662-494-7533
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR718327364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05435572Medicaid
MS302I505626Medicare PIN
MS512I500021Medicare PIN
MSQ70717Medicare UPIN
MS500002156Medicare ID - Type Unspecified