Provider Demographics
NPI:1992975056
Name:KITTRELL, KERRI M (APRN, FNP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:M
Last Name:KITTRELL
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GAUSE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2949
Mailing Address - Country:US
Mailing Address - Phone:985-280-8970
Mailing Address - Fax:985-280-2618
Practice Address - Street 1:901 GAUSE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-280-8970
Practice Address - Fax:985-280-2618
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902322363L00000X, 363LF0000X
LAAP05411363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801020433OtherNPI SMH PHYSICIAN NETWORK
LA5CD84Medicare PIN