Provider Demographics
NPI:1861007957
Name:GRIFFIN, KERRI LANE (CRNP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LANE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 SHEPPARD RD
Mailing Address - Street 2:
Mailing Address - City:REHOBETH
Mailing Address - State:AL
Mailing Address - Zip Code:36301-0731
Mailing Address - Country:US
Mailing Address - Phone:334-429-1200
Mailing Address - Fax:334-335-1217
Practice Address - Street 1:207 HAVEN DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2919
Practice Address - Country:US
Practice Address - Phone:334-793-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116377363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1861007957OtherBLUE CROSS BLUE SHIELD
AL1861007957OtherMEDICARE
AL1861007957Medicaid