Provider Demographics
NPI:1184611204
Name:MATEER, KERRI MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:MARIE
Last Name:MATEER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:875 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2203
Practice Address - Country:US
Practice Address - Phone:717-724-6450
Practice Address - Fax:717-724-6451
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052135363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108766RQJOtherMEDICARE PIN - PINNACLEHE
PA092873EC5OtherMEDICARE PIN - ASSOC CARD
PAP00362151OtherMEDICARE RAILROAD - ASSOC
Q48114Medicare UPIN