Provider Demographics
NPI:1841690658
Name:HEADRICK, KERI ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANN
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-1588
Mailing Address - Country:US
Mailing Address - Phone:573-437-2959
Mailing Address - Fax:573-437-2974
Practice Address - Street 1:704 E HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1588
Practice Address - Country:US
Practice Address - Phone:573-437-2959
Practice Address - Fax:573-437-2974
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039030164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse