Provider Demographics
NPI:1215479506
Name:PHAM, KERRY JO (ARNP, CNM)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:JO
Last Name:PHAM
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 ROYCE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2463
Mailing Address - Country:US
Mailing Address - Phone:850-361-7250
Mailing Address - Fax:850-610-4277
Practice Address - Street 1:975 ROYCE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2463
Practice Address - Country:US
Practice Address - Phone:850-361-7250
Practice Address - Fax:850-610-4277
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265686367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife