Basic Information
| Provider Information | |||||||||
| NPI: | 1811971997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERRIGAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15004 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655229730 | ||||||||
| FaxNumber: | 8656372520 | ||||||||
| Practice Location | |||||||||
| Address1: | 2018 CLINCH AVE, SOUTH TOWER | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659717400 | ||||||||
| FaxNumber: | 8655418611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 200401240 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | 2080P0205X | 0000024835 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 1516053 | 05 | TN | MEDICAID | 10196736 | 05 | VA | MEDICAID | 4247746 | 01 | TN | BCBS | OTHER | 804923 | 01 | NC | PARTNERS | OTHER | 4401155 | 01 | AETNA | OTHER | 890598U | 05 | NC | MEDICAID | D7731 | 01 | NC | MEDCOST | OTHER | Q24835 | 05 | SC | MEDICAID | 0598U | 01 | NC | BCBS | OTHER | 3810003260 | 05 | WV | MEDICAID |