Provider Demographics
NPI:1831150796
Name:KANE, KERRY ANNE (APRN BC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANNE
Last Name:KANE
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANNE
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-0474
Mailing Address - Country:US
Mailing Address - Phone:765-552-7316
Mailing Address - Fax:765-552-7306
Practice Address - Street 1:1520 S R ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-3341
Practice Address - Country:US
Practice Address - Phone:765-552-7316
Practice Address - Fax:765-552-7306
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000740A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200340160Medicaid
IN000000327662OtherANTHEM BCBS
500030087OtherRAILROAD MEDICARE