Provider Demographics
NPI:1437811106
Name:AINSWORTH, KERRY LYNN
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:AINSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 S NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-8652
Mailing Address - Country:US
Mailing Address - Phone:120-970-1832
Mailing Address - Fax:
Practice Address - Street 1:818 N HIGHWAY 67 STE 100B
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2102
Practice Address - Country:US
Practice Address - Phone:972-291-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80889237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist