Basic Information
| Provider Information | |||||||||
| NPI: | 1154807865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORR | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1177 HIGHWAY 315 BLVD | ||||||||
| Address2: | DOLPHIN PLAZA | ||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187026928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702705713 | ||||||||
| FaxNumber: | 5702705719 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 REAR EAST DRINKER STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | DUNMORE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185122469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705582050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2018 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | OA004541 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | MA059932 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.