Provider Demographics
NPI:1972500122
Name:KERR, VICKY E (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:E
Last Name:KERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1632 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1809
Mailing Address - Country:US
Mailing Address - Phone:803-324-1174
Mailing Address - Fax:803-327-4899
Practice Address - Street 1:1632 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1809
Practice Address - Country:US
Practice Address - Phone:803-324-1174
Practice Address - Fax:803-327-4899
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC97503Medicaid
SC97503Medicaid
SCD47489Medicare UPIN