Healthcare Provider Details

I. General information

NPI: 1154532398
Provider Name (Legal Business Name): ALAN ROBERTSON KERR PA-C, PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S STEWART ST SOUTH TEXAS RURAL HEALTH SERVICE
COTULLA TX
78014
US

IV. Provider business mailing address

105 S STEWART ST SOUTH TEXAS RURAL HEALTH SERVICE
COTULLA TX
78014
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-2502
  • Fax:
Mailing address:
  • Phone: 830-879-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA06209
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007203-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9104943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: