Healthcare Provider Details

I. General information

NPI: 1972582500
Provider Name (Legal Business Name): KERRS ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 8TH STREET
SPRINGFIELD SD
57062
US

IV. Provider business mailing address

PO BOX 5126
SIOUX FALLS SD
57117-5126
US

V. Phone/Fax

Practice location:
  • Phone: 605-369-2627
  • Fax: 605-369-5627
Mailing address:
  • Phone: 605-369-2627
  • Fax: 605-369-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GENA L KERR
Title or Position: RN/OFFICE MANABER
Credential: RN
Phone: 605-369-2627