Healthcare Provider Details

I. General information

NPI: 1376092627
Provider Name (Legal Business Name): NICOLE CAROLYN KERR C.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 21ST ST
BAKERSFIELD CA
93301-4002
US

IV. Provider business mailing address

1524 21ST ST
BAKERSFIELD CA
93301-4002
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-1005
  • Fax:
Mailing address:
  • Phone: 661-322-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO005654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: