Provider Demographics
NPI:1295867166
Name:RERKO, IVY L (RN, MSN, ACNP-C, CNS)
Entity Type:Individual
Prefix:MRS
First Name:IVY
Middle Name:L
Last Name:RERKO
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-C, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 LAVACA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8579
Mailing Address - Country:US
Mailing Address - Phone:817-652-9442
Mailing Address - Fax:
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:817-467-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724598363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care