MEDICARE: MICHELLE KIM KERRIGAN

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	207N00000X	Dermatology Physician	1014863	MA
2	207N00000X	Dermatology Physician	100139	GA

General Provider Information

NPI Number	:	1447712054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KIM KERRIGAN

Provider Business Mailing Address
First Line	:	2505 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4464
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8654
Country	:	US
Telephone Number	:	850-233-3376
Fax Number	:	850-522-8354

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	03/04/2026

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Directions to “ MICHELLE KIM KERRIGAN ” Practice Location

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