Provider Demographics
NPI:1558846535
Name:LEE, KERRI (LVN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 SEGURA CT S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2318
Mailing Address - Country:US
Mailing Address - Phone:817-818-8885
Mailing Address - Fax:
Practice Address - Street 1:1314 LAKE ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4582
Practice Address - Country:US
Practice Address - Phone:903-532-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338651164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse