Provider Demographics
NPI:1154678449
Name:RAYMOND, KERI LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LYNN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1165
Mailing Address - Country:US
Mailing Address - Phone:615-257-0900
Mailing Address - Fax:615-443-1444
Practice Address - Street 1:1423 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3061
Practice Address - Country:US
Practice Address - Phone:615-257-0900
Practice Address - Fax:615-443-1444
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant