Healthcare Provider Details

I. General information

NPI: 1164521092
Provider Name (Legal Business Name): NANCY L. KERR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE 4TH FLOOR AMBULATORY CARE CTR
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

933 BRADBURY SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2245
  • Fax: 505-272-1109
Mailing address:
  • Phone: 505-272-3160
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number77-54
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: