Healthcare Provider Details

I. General information

NPI: 1336884667
Provider Name (Legal Business Name): KERRI GLOVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S CLEARVIEW PKWY
HARAHAN LA
70123-3401
US

IV. Provider business mailing address

1 RHINE DR
KENNER LA
70065-1129
US

V. Phone/Fax

Practice location:
  • Phone: 504-736-7386
  • Fax:
Mailing address:
  • Phone: 504-417-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225800
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN108874
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: