Provider Demographics
NPI:1770385601
Name:TAKATA, KERRI (RN)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:TAKATA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324-4001
Mailing Address - Country:US
Mailing Address - Phone:931-308-8454
Mailing Address - Fax:931-308-8454
Practice Address - Street 1:467 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-4001
Practice Address - Country:US
Practice Address - Phone:931-308-8454
Practice Address - Fax:931-308-8454
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN160166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse