=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265487714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERI SUE HARRIS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 E NORTH ST
-----------------------------------------------------
City | CAREY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43316-1068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-396-9205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 885 N SANDUSKY AVE
-----------------------------------------------------
City | UPPER SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43351-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-294-3255
-----------------------------------------------------
Fax | 419-294-6777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 38084044H
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------