Provider Demographics
NPI:1013397199
Name:ANANIA, KERI (PA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:ANANIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 2ND ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-5950
Mailing Address - Country:US
Mailing Address - Phone:308-390-2663
Mailing Address - Fax:308-365-1315
Practice Address - Street 1:112 W 2ND ST STE 3
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-5950
Practice Address - Country:US
Practice Address - Phone:308-390-2663
Practice Address - Fax:308-365-1315
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC363A00000X
NE2068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant