Provider Demographics
NPI:1386002020
Name:AUDETTE, KERRI (LM)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 NW 10TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4752
Mailing Address - Country:US
Mailing Address - Phone:352-275-6731
Mailing Address - Fax:
Practice Address - Street 1:521 NE 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5710
Practice Address - Country:US
Practice Address - Phone:352-377-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife