Healthcare Provider Details

I. General information

NPI: 1114889748
Provider Name (Legal Business Name): JUSTIN KENT KERR CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 TRIVETTE DR STE 302
PIKEVILLE KY
41501-1275
US

IV. Provider business mailing address

126 TRIVETTE DR STE 302
PIKEVILLE KY
41501-1275
US

V. Phone/Fax

Practice location:
  • Phone: 606-471-8357
  • Fax: 606-471-8357
Mailing address:
  • Phone: 606-471-8357
  • Fax: 606-471-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number280736
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: