Provider Demographics
NPI:1881260719
Name:LAWLER, KERRY SHANE (NP-C)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:SHANE
Last Name:LAWLER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 MCCLUSKEY RD
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:AL
Mailing Address - Zip Code:35571-3638
Mailing Address - Country:US
Mailing Address - Phone:205-269-3081
Mailing Address - Fax:
Practice Address - Street 1:570 MCCLUSKEY RD
Practice Address - Street 2:
Practice Address - City:HODGES
Practice Address - State:AL
Practice Address - Zip Code:35571-3638
Practice Address - Country:US
Practice Address - Phone:205-269-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily