Provider Demographics
NPI:1154346476
Name:KERR, JENNIFER BERGIN (MPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BERGIN
Last Name:KERR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2206
Mailing Address - Country:US
Mailing Address - Phone:405-919-7668
Mailing Address - Fax:
Practice Address - Street 1:430 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3910
Practice Address - Country:US
Practice Address - Phone:405-606-3311
Practice Address - Fax:405-606-3081
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist