Healthcare Provider Details

I. General information

NPI: 1760891071
Provider Name (Legal Business Name): RITA HUSPEN KERR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10877 CONDUCTOR BLVD
SUTTER CREEK CA
95685-9687
US

IV. Provider business mailing address

10877 CONDUCTOR BLVD
SUTTER CREEK CA
95685-9687
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-6407
  • Fax: 209-267-9808
Mailing address:
  • Phone: 209-223-6407
  • Fax: 209-267-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG72170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: