Provider Demographics
NPI:1639131113
Name:MCGUIRE, KERRY E (NP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:E
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:860-324-0704
Mailing Address - Fax:
Practice Address - Street 1:850 ENTERPRISE PKWY STE 1300
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6251
Practice Address - Country:US
Practice Address - Phone:757-827-7754
Practice Address - Fax:757-827-0995
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177744363LA2200X
CT003310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246634Medicaid
Q27810Medicare UPIN
CTD400002844 - C00814Medicare PIN
Q27810Medicare UPIN