Provider Demographics
NPI:1932549193
Name:WYNN, KERI G (DVM)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:G
Last Name:WYNN
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 E DORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41256-9011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 RHUBENS BR
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-6714
Practice Address - Country:US
Practice Address - Phone:606-673-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4706174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian