Healthcare Provider Details

I. General information

NPI: 1013493865
Provider Name (Legal Business Name): KERRI LYNCH MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST
GIDEON MO
63848-9253
US

IV. Provider business mailing address

100 N MAIN ST
GIDEON MO
63848-9253
US

V. Phone/Fax

Practice location:
  • Phone: 573-448-3800
  • Fax: 573-448-8909
Mailing address:
  • Phone: 573-448-3800
  • Fax: 573-448-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018026783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: