Provider Demographics
NPI:1881169092
Name:AVEDON, KERRI J (RN)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:J
Last Name:AVEDON
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 1:1727 AUTUMN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7937
Mailing Address - Country:US
Mailing Address - Phone:623-451-2600
Mailing Address - Fax:
Practice Address - Street 1:1727 AUTUMN RIDGE LN
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7937
Practice Address - Country:US
Practice Address - Phone:623-451-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX954216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse