MEDICARE: STACY KERR RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	643210	TX

General Provider Information

NPI Number	:	1033961073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY KERR RN

Provider Business Mailing Address
First Line	:	8990 KIRBY DR STE 220
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2853
Country	:	US
Telephone Number	:	832-771-0433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 ACACIAWOOD WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-0006
Country	:	US
Telephone Number	:	832-771-0433
Fax Number	:	855-228-7878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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