Individual
STACEY KERR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8 RICHLAND MEDICAL PARK DR STE 420, COLUMBIA, SC 29203-8004
(803) 434-8050
(803) 933-3005
Mailing address
353 FAIRMONT BLVD, ATTEN CHRISTIE MSS, RAPID CITY, SD 57701-7350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3943
SC
363AM0700X
Medical Physician Assistant
0900
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4665PA
—
SC
Enumeration date
09/19/2012
Last updated
08/10/2022
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