Provider Demographics
NPI:1205959921
Name:ELDRIDGE, KERRY ELIZABETH (CNM, NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ELIZABETH
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14629 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:FOREST RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95942-9773
Mailing Address - Country:US
Mailing Address - Phone:530-893-9571
Mailing Address - Fax:
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-532-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1668367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife