Healthcare Provider Details

I. General information

NPI: 1235795543
Provider Name (Legal Business Name): MIKE KERR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

IV. Provider business mailing address

PO BOX 1453
HUGHSON CA
95326-1453
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number818824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: