Healthcare Provider Details

I. General information

NPI: 1639431638
Provider Name (Legal Business Name): JOANNA HEDEN KERR CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD 1300
MARIETTA GA
30062-1266
US

IV. Provider business mailing address

2222 HERITAGE TRACE VW
MARIETTA GA
30062-6363
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN191560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: