Provider Demographics
NPI:1639351893
Name:KREIDEL, KERRY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LYNNE
Last Name:KREIDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:MCGONIGLE
Other - Last Name:KREIDEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9319 OAK LEDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5127
Mailing Address - Country:US
Mailing Address - Phone:520-343-9236
Mailing Address - Fax:
Practice Address - Street 1:GOOD SAMARITAN REGIONAL MEDICAL CENTER
Practice Address - Street 2:3600 NW SAMARITAN DR
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-768-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0070496207L00000X
NV21926207L00000X
AZ44732207L00000X
ORMD216184207L00000X
TXR0051207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology