Basic Information
Provider Information
NPI: 1003150269
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAYS
FirstName: KERRI
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: BS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WEISEMAN
OtherFirstName: KERRI
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 568
Address2:  
City: CORBIN
State: KY
PostalCode: 407020568
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1203 AMERICAN GREETING CARD RD
Address2:  
City: CORBIN
State: KY
PostalCode: 407014811
CountryCode: US
TelephoneNumber: 6065287010
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/12/2012
LastUpdateDate: 11/12/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


Home