Provider Demographics
NPI:1609837301
Name:KERR, EILEEN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANN
Last Name:KERR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HENNEPIN HEALTHCARE EAST LAKE CLINIC
Mailing Address - Street 2:2700 E. LAKE ST #1100
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55406
Mailing Address - Country:US
Mailing Address - Phone:612-873-6963
Mailing Address - Fax:612-276-0188
Practice Address - Street 1:2700 E LAKE ST
Practice Address - Street 2:#1100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1963
Practice Address - Country:US
Practice Address - Phone:612-873-8100
Practice Address - Fax:612-276-0177
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9402363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN507428200Medicaid
MN123263OtherUCARE
MN01-20856OtherMEDICA
MNNA9021020591OtherPREFERRED ONE
MN77B41KEOtherBCBS
MNHP30472OtherHEALTH PARTNERS