Healthcare Provider Details

I. General information

NPI: 1528364437
Provider Name (Legal Business Name): KERI THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERI BURLESON PA-C

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR STE 301
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

5849 COLFAX AVE
ALEXANDRIA VA
22311
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-6431
  • Fax: 571-665-6826
Mailing address:
  • Phone: 202-476-2157
  • Fax: 202-476-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA030945
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC05067
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003530
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003530
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: