Provider Demographics
NPI:1982689089
Name:KERRIGAN, MICHAEL J (FNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:KERRIGAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:375 N EASTOWN RD STE C
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2209
Practice Address - Country:US
Practice Address - Phone:419-224-4646
Practice Address - Fax:419-224-2410
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.03479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2082955Medicaid
OHP00191349OtherRAILROAD INSURANCE
OH000000213037OtherANTHEM
MI4688815Medicaid
MI4719831Medicaid
MIP010447OtherBLUE CROSS NETWORK OF MIC
OHNP00787Medicare PIN
MI4719831Medicaid
OHNP00788Medicare PIN
OH2082955Medicaid
OHNP00788Medicare PIN
MI4719831Medicaid
OHNP00787Medicare PIN