Healthcare Provider Details

I. General information

NPI: 1992190599
Provider Name (Legal Business Name): MICHELLE KERR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # OC.7420
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone: 206-987-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML60561409
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number61042173
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: