Basic Information
| Provider Information | |||||||||
| NPI: | 1730406125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEMORE | ||||||||
| FirstName: | KERRIE | ||||||||
| MiddleName: | RANAE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1533 S BROWNLEE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784043131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618842242 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2606 HOSPITAL BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784051804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619024789 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M8829 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P02601786 | 01 | TX | MCRR | OTHER | 287586604 | 05 | TX | MEDICAID | 1L4473 | 01 | TX | MEDICARE | OTHER | 8CM223 | 01 | TX | BCBS OF TX | OTHER | PENDING | 05 | TX | MEDICAID |