Provider Demographics
NPI:1720590789
Name:KERR, SHAYNA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:MARIE
Last Name:KERR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:MARIE
Other - Last Name:RUNYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5364
Mailing Address - Country:US
Mailing Address - Phone:410-296-7190
Mailing Address - Fax:443-991-7768
Practice Address - Street 1:8 DENTON PLZ
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-9501
Practice Address - Country:US
Practice Address - Phone:443-606-2300
Practice Address - Fax:443-606-2305
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily