Healthcare Provider Details

I. General information

NPI: 1639131113
Provider Name (Legal Business Name): KERRY E. MCGUIRE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 ENTERPRISE PKWY STE 1300
HAMPTON VA
23666-6251
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7754
  • Fax: 757-827-0995
Mailing address:
  • Phone: 860-324-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024177744
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: