Healthcare Provider Details

I. General information

NPI: 1609343003
Provider Name (Legal Business Name): KERRICA WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 ABLE CT
MOBILE AL
36693-3100
US

IV. Provider business mailing address

5462 CROSS CREEK DR
MOBILE AL
36693-4004
US

V. Phone/Fax

Practice location:
  • Phone: 251-649-4420
  • Fax:
Mailing address:
  • Phone: 251-508-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: