Provider Demographics
NPI:1093697765
Name:KERRICK, CHLOE (PA-C)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:KERRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 WEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SYMSONIA
Mailing Address - State:KY
Mailing Address - Zip Code:42082-9500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:543 POWELL LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5366
Practice Address - Country:US
Practice Address - Phone:270-415-7070
Practice Address - Fax:270-415-7071
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYTC60363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant