Provider Demographics
NPI:1578033981
Name:CALDWELL, KERRI SUE (PARENT PARTNER)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:SUE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PARENT PARTNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 W HOBSONWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1423
Mailing Address - Country:US
Mailing Address - Phone:760-921-5000
Mailing Address - Fax:
Practice Address - Street 1:1297 W. HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225
Practice Address - Country:US
Practice Address - Phone:760-921-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker