Provider Demographics
NPI:1972927770
Name:HENDRICKS, KERRI (RN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-9295
Mailing Address - Country:US
Mailing Address - Phone:928-651-5316
Mailing Address - Fax:
Practice Address - Street 1:925 W CASTLE RD
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-9295
Practice Address - Country:US
Practice Address - Phone:928-651-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN133739163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse