Provider Demographics
NPI:1578380317
Name:KERRIGAN, KAYLAN JEAN (CRNA, CCRN, BSN, RN)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:JEAN
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:CRNA, CCRN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DRAVOSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15034-1046
Mailing Address - Country:US
Mailing Address - Phone:267-337-4507
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114043163W00000X
PARN716491163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse