MEDICARE: MARY R KERR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M-13881	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M13881	OTHER	ID	STATE LICENSE

General Provider Information

NPI Number	:	1144244054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY R KERR MD

Provider Business Mailing Address
First Line	:	823 E AMITY AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-1053
Country	:	US
Telephone Number	:	208-467-8428
Fax Number	:	800-934-4028

Provider Business Practice Location Address
First Line	:	823 E AMITY AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-1053
Country	:	US
Telephone Number	:	208-467-8428
Fax Number	:	800-934-4028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/12/2026

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Directions to “ MARY R KERR MD” Practice Location

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