Provider Demographics
NPI:1720493893
Name:CLARK, KERRI LYN (MSN, CPNP-AC, CCRN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LYN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSN, CPNP-AC, CCRN
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:LYN
Other - Last Name:BAUMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8639
Mailing Address - Fax:330-543-8136
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8639
Practice Address - Fax:330-543-8136
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16106-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner