Provider Demographics
NPI:1740477140
Name:KERSH, NICOLE VANNOR (M D)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:VANNOR
Last Name:KERSH
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PLANTATION POINTE # 300
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2962
Mailing Address - Country:US
Mailing Address - Phone:251-990-1922
Mailing Address - Fax:
Practice Address - Street 1:82 PLANTATION POINTE # 300
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2962
Practice Address - Country:US
Practice Address - Phone:251-990-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD30174207R00000X, 208000000X, 208M00000X
FLME110605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I114027Medicare PIN
AL102I114027Medicare PIN
AL138408Medicaid
AL51125157OtherBLUE CROSS