Provider Demographics
NPI:1952752743
Name:NEWBERRY, KERI
Entity Type:Individual
Prefix:MISS
First Name:KERI
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KERI
Other - Middle Name:LYNN
Other - Last Name:BODEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9835 E TONTO DR
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-6916
Mailing Address - Country:US
Mailing Address - Phone:928-632-5331
Mailing Address - Fax:
Practice Address - Street 1:9835 E TONTO DR
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-6916
Practice Address - Country:US
Practice Address - Phone:928-632-5331
Practice Address - Fax:928-910-2090
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD01309813172A00000X, 235Z00000X
174200000X, 252Y00000X, 305S00000X, 372500000X, 372600000X, 376J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency
No305S00000XManaged Care OrganizationsPoint of Service
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SAMDFASPROD03OtherKERI, LYNN, BODEN / KERI NEWBERRY (PRIVATE)
AZ411645001OtherONE AZ CREDIT UNION (ARIZONA STATE SAVINGS AND CREDIT UNION / KERI NEWBERRY)
AZD01309813OtherKERI, LYNN, BODEN / KERI NEWBERRY (DRIVER LICENSE)
AZ251525OtherARIZONA DEPARTMENT OF CORRECTIONS