Provider Demographics
NPI:1215946009
Name:KERWIN, VICKI BOWERS (CFNP)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:BOWERS
Last Name:KERWIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 EARL CORE ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25962
Mailing Address - Country:US
Mailing Address - Phone:304-285-5515
Mailing Address - Fax:304-285-5524
Practice Address - Street 1:1401 EARL CORE ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:25962
Practice Address - Country:US
Practice Address - Phone:304-285-5515
Practice Address - Fax:304-285-5524
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003635Medicaid
WV3810003635Medicaid
KENP18141Medicare ID - Type Unspecified