Healthcare Provider Details

I. General information

NPI: 1780347724
Provider Name (Legal Business Name): KEVIN CLINTON KERRICK PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE STE 200-2010
MIAMI FL
33193-5826
US

IV. Provider business mailing address

8785 SW 165TH AVE STE 200-2010
MIAMI FL
33193-5826
US

V. Phone/Fax

Practice location:
  • Phone: 305-709-1950
  • Fax: 305-847-0418
Mailing address:
  • Phone: 305-510-2302
  • Fax: 305-847-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: