Provider Demographics
NPI:1760527741
Name:KERLEY, KRISTIN THOMPSON (FNP-BC, PNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:THOMPSON
Last Name:KERLEY
Suffix:
Gender:F
Credentials:FNP-BC, PNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-9010
Mailing Address - Country:US
Mailing Address - Phone:601-506-3163
Mailing Address - Fax:
Practice Address - Street 1:1500 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5335
Practice Address - Country:US
Practice Address - Phone:601-696-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851045363LF0000X, 363LP0200X
FL11018511363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics