Provider Demographics
NPI:1619178894
Name:KERI, MATTHEW MICHAEL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:KERI
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E ST., NW SA-1
Mailing Address - Street 2:SUITE L209
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-663-1649
Mailing Address - Fax:202-663-1613
Practice Address - Street 1:2401 E ST., NW SA-1
Practice Address - Street 2:SUITE L209
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-663-1649
Practice Address - Fax:202-663-1613
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0014160163W00000X
WAAP0006796363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642430Medicaid
WA9642430Medicaid
WAQ27295Medicare UPIN