Provider Demographics
NPI:1720326184
Name:KERR, ELIZABETH DENALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DENALI
Last Name:KERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENALI
Other - Middle Name:
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:209 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4267
Mailing Address - Country:US
Mailing Address - Phone:253-596-3300
Mailing Address - Fax:253-596-3301
Practice Address - Street 1:21616 76TH AVE W STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-640-4810
Practice Address - Fax:425-640-4884
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61002555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720326184Medicaid