Basic Information
| Provider Information | |||||||||
| NPI: | 1861007957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | LANE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 783 SHEPPARD RD | ||||||||
| Address2: | |||||||||
| City: | REHOBETH | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363010731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3344291200 | ||||||||
| FaxNumber: | 3343351217 | ||||||||
| Practice Location | |||||||||
| Address1: | 58 ROY BEALL DR | ||||||||
| Address2: | |||||||||
| City: | LUVERNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360496800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343351212 | ||||||||
| FaxNumber: | 3343351217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2020 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 1-116377 | AL | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 1-116377 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.