Provider Demographics
NPI:1639431638
Name:KERR, JOANNA HEDEN (CPNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:HEDEN
Last Name:KERR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 HERITAGE TRACE VW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3225 SHALLOWFORD RD
Practice Address - Street 2:1300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1266
Practice Address - Country:US
Practice Address - Phone:678-560-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191560363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics