Provider Demographics
NPI:1366023046
Name:HALE, KERI TUTEN (NP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:TUTEN
Last Name:HALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-8593
Mailing Address - Country:US
Mailing Address - Phone:912-670-0480
Mailing Address - Fax:
Practice Address - Street 1:1701 BOULEVARD SQ STE D
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8022
Practice Address - Country:US
Practice Address - Phone:912-387-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248323163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse