Provider Demographics
NPI:1942459201
Name:STRAIGHT, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:STRAIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 N PLEASANTS HWY
Mailing Address - Street 2:BOX 210
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-4993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2272 N PLEASANTS HWY
Practice Address - Street 2:BOX 210
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-4993
Practice Address - Country:US
Practice Address - Phone:304-684-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV63182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012866Medicaid