Healthcare Provider Details

I. General information

NPI: 1427021328
Provider Name (Legal Business Name): JEFFERY HAYES KERR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 N BROADWAY ST SUITE A
POTEAU OK
74953-9433
US

IV. Provider business mailing address

5021 N BROADWAY ST SUITE A
POTEAU OK
74953-9433
US

V. Phone/Fax

Practice location:
  • Phone: 918-647-9477
  • Fax: 918-647-4595
Mailing address:
  • Phone: 918-647-9477
  • Fax: 918-647-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2830-94
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5834
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: