Provider Demographics
NPI:1205583564
Name:SEYMORE, KERI (RN)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:SEYMORE
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 1:1801 W BAY DR NW STE 104
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4310
Mailing Address - Country:US
Mailing Address - Phone:360-451-1552
Mailing Address - Fax:
Practice Address - Street 1:4570 AVERY LN SE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5608
Practice Address - Country:US
Practice Address - Phone:360-764-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00140077163WP0808X
WAAP6133520363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health