Provider Demographics
NPI:1841334315
Name:FORD, KERRIE MEGAN (PA-C, MPH)
Entity type:Individual
Prefix:MS
First Name:KERRIE
Middle Name:MEGAN
Last Name:FORD
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 TUSCANY MILL WAY
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-9178
Mailing Address - Country:US
Mailing Address - Phone:407-298-5068
Mailing Address - Fax:
Practice Address - Street 1:63 W UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1118
Practice Address - Country:US
Practice Address - Phone:407-872-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100990363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical