Healthcare Provider Details

I. General information

NPI: 1114303559
Provider Name (Legal Business Name): CARRIE ANNE KERBY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2015
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HALLMARK DR
EATON OH
45320-8648
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICE
RICHMOND IN
47374
US

V. Phone/Fax

Practice location:
  • Phone: 937-456-4181
  • Fax: 937-456-4649
Mailing address:
  • Phone: 765-935-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007000A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17936
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: