Kerri Petitpain Medical

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

KERRI PETITPAIN MEDICAL

Practice address

18 Scott LN
Manorville, NY 11949-2624

Phone

(631) 905-6890

Fax

(888) 920-2296

NPI assigned

Apr 2, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kerri Ann Petitpain, DNP-CNPI 1760621304

Title

Practitioner/Owner

Phone

(631) 905-6890

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kerri Petitpain Medical Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerri Ann Petitpain

  • Family Nurse Practitioner
  • Manorville, NY
  • NPI 1760621304
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1184253262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 SCOTT LN",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119492624",
            "telephone_number": "631-905-6890",
            "fax_number": "888-920-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 SCOTT LN",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119492624",
            "telephone_number": "631-905-6890",
            "fax_number": "888-920-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRI PETITPAIN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "PETITPAIN",
        "authorized_official_first_name": "KERRI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "631-905-6890",
        "authorized_official_credential": "DNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03410419",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kerri Petitpain Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Maria Josephs, PT
• Samantha Justesen
• Cori Lynn Kapopoulos, LCSW
• Denise M Karavas, PA
• Lester S. Keller, DPM
• John M Kiesecker, D.C.
• Judi-Ann Killean, RN
• Kinexion Medical Services, P.C.
• King Kullen Pharmacies Corp
• Christina Koch, RBT

• Family Nurse Practitioner in Manorville, NY
• Providers in Manorville, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.