Healthcare Provider Details

I. General information

NPI: 1013090430
Provider Name (Legal Business Name): KERRI RYDER PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRI MURPHY

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CHANDLER ST
WORCESTER MA
01602
US

IV. Provider business mailing address

PO BOX 6
PELHAM NH
03076-0006
US

V. Phone/Fax

Practice location:
  • Phone: 508-799-0688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN225383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: