Provider Demographics
NPI:1285187161
Name:CODUTI, KERRI
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CODUTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 N JOSEY LN
Mailing Address - Street 2:#104
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2484
Mailing Address - Country:US
Mailing Address - Phone:972-492-0333
Mailing Address - Fax:
Practice Address - Street 1:3730 N JOSEY LN
Practice Address - Street 2:#104
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2484
Practice Address - Country:US
Practice Address - Phone:972-492-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130609363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health