Provider Demographics
NPI:1669457693
Name:NORTH-CALDERON, KERRIE SUZANNE (PA C)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:SUZANNE
Last Name:NORTH-CALDERON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6533
Mailing Address - Country:US
Mailing Address - Phone:530-626-2920
Mailing Address - Fax:530-626-2974
Practice Address - Street 1:1095 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8238
Practice Address - Country:US
Practice Address - Phone:530-626-2920
Practice Address - Fax:530-626-2974
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72819Medicare UPIN
OPA130610Medicare ID - Type Unspecified