Provider Demographics
NPI:1053723544
Name:BOOKER, KERRI NOEL (RDH, MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:KERRI
Middle Name:NOEL
Last Name:BOOKER
Suffix:
Gender:F
Credentials:RDH, MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2005
Practice Address - Country:US
Practice Address - Phone:570-271-6812
Practice Address - Fax:570-271-6507
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA057054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106722OtherPROVIDER ID