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General NPI Number Information
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NPI Number | 1710951959
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Entity Type | Individual
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Provider Name | JEREMY RICHARD KERSEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | MSC09 5040 1 UNIVERSITY OF NEW MEXICO
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-2100
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Country | US
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Telephone | 505-219-6614
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 BROADMOOR BLVD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-2100
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Country | US
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Telephone | 505-994-7000
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2015-0047
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License Number State | NM
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