Healthcare Provider Details

I. General information

NPI: 1982966842
Provider Name (Legal Business Name): SHELLINE KERR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 LENOX RD
BROOKLYN NY
11203-2617
US

IV. Provider business mailing address

939 LENOX RD
BROOKLYN NY
11203-2617
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2245
  • Fax:
Mailing address:
  • Phone: 718-485-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number655617
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF339918-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339918-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: