Provider Demographics
NPI:1659709285
Name:KERRIGAN, KATHLEEN (RDMS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 WYCLIFFE CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-7347
Mailing Address - Country:US
Mailing Address - Phone:775-750-4004
Mailing Address - Fax:
Practice Address - Street 1:31 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-4510
Practice Address - Country:US
Practice Address - Phone:215-646-8607
Practice Address - Fax:866-308-0330
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV168622471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16862OtherRDMS LICENSE