Provider Demographics
NPI:1629419908
Name:SUITS, KERRIE ROCHELLE (NP)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:ROCHELLE
Last Name:SUITS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERRIE
Other - Middle Name:ROCHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11521 FISHERS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1860
Mailing Address - Country:US
Mailing Address - Phone:317-842-1188
Mailing Address - Fax:317-842-8522
Practice Address - Street 1:11521 FISHERS DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1860
Practice Address - Country:US
Practice Address - Phone:317-842-1188
Practice Address - Fax:317-842-8522
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004486A363L00000X
IN28172055A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28172055AOtherSTATE LICENSE