Shuffelbottom, Kerry Kathleen

Shuffelbottom, Kerry Kathleen is an individual health care provider with primary practice located at 200 Blue Moon Xing Ste 203 , Pooler GA 31322-9698. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Shuffelbottom, Kerry Kathleen can be contacted via phone (912) 590-0973.

Contact Information

Primary practice address
200 Blue Moon Xing Ste 203 Pooler GA 31322-9698
Phone: (912) 590-0973
Fax: (912) 590-0180
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 2131 South Carolina
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2131 South Carolina

Profile Details

NPI number 1902102676
LBN Legal business name Shuffelbottom, Kerry Kathleen
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 28th, 2011
Last updated Oct 12th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902102676 NPPES
Florida Other Y06PS BCBS
Florida MEDICAID 0032613-00 BCBS

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