Provider Demographics
NPI:1063861755
Name:FLORES, KEREN (LVN)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 S HAUSMAN RD
Mailing Address - Street 2:APT 7
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3964
Mailing Address - Country:US
Mailing Address - Phone:830-765-1373
Mailing Address - Fax:
Practice Address - Street 1:11480 S HAUSMAN RD
Practice Address - Street 2:APT 7
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3964
Practice Address - Country:US
Practice Address - Phone:830-765-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210699164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210699OtherSTATE OF TEXAS