Provider Demographics
NPI:1104163724
Name:WYRICK, KERRI DAWN
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:DAWN
Last Name:WYRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SUMMIT CIR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7443
Mailing Address - Country:US
Mailing Address - Phone:580-298-7886
Mailing Address - Fax:
Practice Address - Street 1:715 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3801
Practice Address - Country:US
Practice Address - Phone:580-931-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor