Provider Demographics
NPI:1952490260
Name:YANCY, KERRY J (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:J
Last Name:YANCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-1410
Practice Address - Fax:225-374-1616
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8531207PP0204X
MS25766207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669442042OtherGROUP NPI NUMBER
TX806172OtherFIRSTHEALTH PIN
TX107492OtherSUPERIOR PIN
TX1159787OtherUHC PIN
TX8731B7OtherBCBSTX IND PIN
TX8731B7OtherIND MEDICARE
1669442042OtherGRP NPI NUMBER
TX127409100OtherFIRSTCARE PIN
TX4572510OtherAETNA PIN
TX135003511Medicaid
TX137283103Medicaid
1669442042OtherGRP NPI NUMBER
TX8731B7OtherIND MEDICARE
TX137345805Medicaid
TX806172OtherFIRSTHEALTH PIN
TX127409100OtherFIRSTCARE PIN
TX10024770OtherAMERIGROUP PIN
TX135003511Medicaid