Provider Demographics
NPI:1932548062
Name:SEYMOUR, KERRI LEA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LEA
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3331
Mailing Address - Country:US
Mailing Address - Phone:580-286-1095
Mailing Address - Fax:
Practice Address - Street 1:2615 SENTINEL WAY STE 300
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2799
Practice Address - Country:US
Practice Address - Phone:469-790-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85946363LF0000X
TX1094693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily