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General NPI Number Information
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NPI Number | 1235480005
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Entity Type | Individual
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Provider Name | STACEY KERR PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 8 RICHLAND MEDICAL PARK DR STE 420
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City | COLUMBIA
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State | SC
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Zip | 29203-8004
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Country | US
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Telephone | 803-434-8050
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Fax | 803-933-3005
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Provider Business Mailing Address
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Address Line | 353 FAIRMONT BLVD ATTEN CHRISTIE MSS
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City | RAPID CITY
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State | SD
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Zip | 57701-7350
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0900
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3943
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License Number State | SC
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