Provider Demographics
NPI:1265403588
Name:KREMER, KERRI LESLIE (ARNP, FNP-C, RNFA)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LESLIE
Last Name:KREMER
Suffix:
Gender:F
Credentials:ARNP, FNP-C, RNFA
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:LESILIE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, RNFA
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-473-0637
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:560 GAGE BLVD STE 101&206
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8650
Practice Address - Country:US
Practice Address - Phone:509-946-1654
Practice Address - Fax:509-943-5652
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60045990363LF0000X, 363L00000X
WARN00095775163WM0705X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9611559Medicaid
WA174428OtherLABOR & INDUSTRIES
WA174428OtherLABOR & INDUSTRIES
AZZ149142Medicare PIN