Provider Demographics
NPI:1841415916
Name:RISCO, KERRY GRIFFITH (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:GRIFFITH
Last Name:RISCO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:SUE
Other - Last Name:RISCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:1083 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2859
Mailing Address - Country:US
Mailing Address - Phone:814-333-2809
Mailing Address - Fax:
Practice Address - Street 1:1083 WOODMONT DR
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2859
Practice Address - Country:US
Practice Address - Phone:814-333-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001837B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily