Provider Demographics
NPI:1265886303
Name:KERMIS, RACHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:
Last Name:KERMIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 PICARDY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3674
Mailing Address - Country:US
Mailing Address - Phone:225-763-4920
Mailing Address - Fax:
Practice Address - Street 1:8595 PICARDY AVE STE 200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3674
Practice Address - Country:US
Practice Address - Phone:225-763-4920
Practice Address - Fax:225-763-4916
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA319990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program