Basic Information
| Provider Information | |||||||||
| NPI: | 1376270397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | KERRY-ANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 NW 150TH AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544319838 | ||||||||
| FaxNumber: | 9542416726 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 NW 150TH AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544319838 | ||||||||
| FaxNumber: | 9542416726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2022 | ||||||||
| LastUpdateDate: | 10/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 9300000 | FL | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 11021199 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.