Provider Demographics
NPI:1871004093
Name:FAREK, KERI LEIGH (LVN)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LEIGH
Last Name:FAREK
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 1:108 N ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5415
Mailing Address - Country:US
Mailing Address - Phone:254-498-5295
Mailing Address - Fax:
Practice Address - Street 1:108 N ANDREWS DR
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-5415
Practice Address - Country:US
Practice Address - Phone:254-498-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339366164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse