Provider Demographics
NPI:1508293374
Name:DRAGANIC, KERI LYN (NP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYN
Last Name:DRAGANIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:LYN
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:469-291-2841
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-633-5555
Practice Address - Fax:214-648-9104
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner