Healthcare Provider Details

I. General information

NPI: 1265703789
Provider Name (Legal Business Name): MR. ADAM M KERR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

IV. Provider business mailing address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

V. Phone/Fax

Practice location:
  • Phone: 971-295-0540
  • Fax:
Mailing address:
  • Phone: 971-295-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-955A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201400593CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: