Provider Demographics
NPI:1821047168
Name:TABBEY, KERRY LYNN (CRNA, MS)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:TABBEY
Suffix:
Gender:F
Credentials:CRNA, MS
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Other - First Name:
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Mailing Address - Street 1:12065 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2878
Mailing Address - Country:US
Mailing Address - Phone:734-416-1740
Mailing Address - Fax:
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-3840
Practice Address - Fax:734-712-5526
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704150035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered