MEDICARE: WILLIAM KERREL ARD JR. LMSW

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	1041C0700X	Clinical Social Worker	10543	TN

General Provider Information

NPI Number	:	1316490550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM KERREL ARD JR. LMSW

Provider Business Mailing Address
First Line	:	2038 JEFFERSON AVE APT 3
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2736
Country	:	US
Telephone Number	:	901-692-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2038 JEFFERSON AVE APT 3
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2736
Country	:	US
Telephone Number	:	901-692-4411
Fax Number	:

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

Provider Enumeration Date	:	07/24/2016
Last Update Date	:	07/24/2016

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