Provider Demographics
NPI:1740452440
Name:PRATER, KERI (RDA)
Entity type:Individual
Prefix:MS
First Name:KERI
Middle Name:
Last Name:PRATER
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-0567
Mailing Address - Country:US
Mailing Address - Phone:931-589-2515
Mailing Address - Fax:931-589-3783
Practice Address - Street 1:100 PERRY STREET
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-0567
Practice Address - Country:US
Practice Address - Phone:931-589-2515
Practice Address - Fax:931-589-3783
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10825126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant