Provider Demographics
NPI:1013760180
Name:KERBYSON, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:KERBYSON
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 1:2338 BYRON CENTER AVE SW APT 5
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-1697
Mailing Address - Country:US
Mailing Address - Phone:909-499-0336
Mailing Address - Fax:
Practice Address - Street 1:2338 BYRON CENTER AVE SW APT 5
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-1697
Practice Address - Country:US
Practice Address - Phone:909-499-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider