Just your usual...
Paige (or full name)
or, instead of writing your name & addy at the top above Kerry's, I always put mine after the sign-off...
Paige Eastman Dickinson, CPM
My Town, MA Zip
My website (because it is relevant for this purpose in my case)
PS I would also make sure I put in the subject line of the email somethink like "Certified Professional Midwives on the Medicaid Provider List"