MEDICARE: KRISTIN THOMPSON KERLEY FNP-BC, PNP-BC, NP-C

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	363LF0000X	Family Nurse Practitioner	R851045	MS
2	363LF0000X	Family Nurse Practitioner	11018511	FL
3	363LP0200X	Pediatric Nurse Practitioner	R851045	MS
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11018511	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760527741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN THOMPSON KERLEY FNP-BC, PNP-BC, NP-C

Provider Business Mailing Address
First Line	:	894 LAMAR ST
Second Line	:
City	:	MARION
State	:	MS
Zip	:	39342-9010
Country	:	US
Telephone Number	:	601-506-3163
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 HIGHWAY 19 N
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39307-5335
Country	:	US
Telephone Number	:	601-696-3232
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	03/30/2023

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Directions to “ KRISTIN THOMPSON KERLEY FNP-BC, PNP-BC, NP-C” Practice Location

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