Provider Demographics
NPI:1033846266
Name:SMITH, KERRY DENISE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:DENISE
Other - Last Name:VAUGHN VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-6149
Mailing Address - Country:US
Mailing Address - Phone:361-350-1296
Mailing Address - Fax:
Practice Address - Street 1:600 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2235
Practice Address - Country:US
Practice Address - Phone:361-350-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086575363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care