Provider Demographics
NPI:1760046320
Name:RAPHEAL, KERRY-ANN LEONIE (BS, ICCE, CLC)
Entity Type:Individual
Prefix:MRS
First Name:KERRY-ANN
Middle Name:LEONIE
Last Name:RAPHEAL
Suffix:
Gender:F
Credentials:BS, ICCE, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MILESTONE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3575
Mailing Address - Country:US
Mailing Address - Phone:410-948-5626
Mailing Address - Fax:
Practice Address - Street 1:319 MILESTONE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3575
Practice Address - Country:US
Practice Address - Phone:410-948-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
280574174N00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN