Healthcare Provider Details

I. General information

NPI: 1154351658
Provider Name (Legal Business Name): THOMAS CALVIN KERR N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 SOUTH STATE ROAD 25
LOGANSPORT IN
46947-0000
US

IV. Provider business mailing address

1098 S STATE ROAD 25
LOGANSPORT IN
46947-6723
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-4141
  • Fax: 574-737-3907
Mailing address:
  • Phone: 574-722-4141
  • Fax: 574-737-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002068A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: