Provider Demographics
NPI:1689914632
Name:ERVIN, KERRI A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:A
Last Name:ERVIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1109
Mailing Address - Country:US
Mailing Address - Phone:731-623-5053
Mailing Address - Fax:731-623-5054
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1109
Practice Address - Country:US
Practice Address - Phone:731-623-5053
Practice Address - Fax:731-623-5054
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily