Provider Demographics
NPI:1508417890
Name:CONSTABLE, KERI MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:MICHELLE
Last Name:CONSTABLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:MICHELLE
Other - Last Name:SCHRUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13320-0214
Mailing Address - Country:US
Mailing Address - Phone:785-307-3962
Mailing Address - Fax:
Practice Address - Street 1:63 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13320-3563
Practice Address - Country:US
Practice Address - Phone:785-307-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse