Active NPI
Kerrie Fallon
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1811369911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9109073
- Practice address
- 3599 University Blvd S
BLDG 300
Jacksonville, FL 32216-4252 - Phone
- (904) 399-5550
- Fax
- (904) 346-4334
- NPI assigned
- Oct 28, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9109073 | FL | Primary |
Addresses
Primary practice location
3599 University Blvd S
BLDG 300
Jacksonville, FL 32216-4252
Mailing address
3599 University Blvd S
BLDG 300
Jacksonville, FL 32216-4252
Phone (904) 399-5550
Other names 1
- Kerrie Ann Green
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia Radiology Imaging Consultants, LLC | Past | Accepting new patients | |
| Mori Bean and Brooks Inc | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Tampa, FL
- NPI 1093782070
Physician Assistant
-
- Diagnostic Radiology Physician
- Harvey, IL
- NPI 1831461771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503273600000",
"number": "1811369911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3599 UNIVERSITY BLVD S",
"address_2": "BLDG 300",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164252",
"telephone_number": "904-399-5550",
"fax_number": "904-346-4334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3599 UNIVERSITY BLVD S",
"address_2": "BLDG 300",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164252",
"telephone_number": "904-399-5550",
"fax_number": "904-346-4334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FALLON",
"first_name": "KERRIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-28",
"last_updated": "2017-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9109073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KERRIE",
"last_name": "GREEN",
"middle_name": "ANN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.