Provider Demographics
NPI:1528616513
Name:DEXTER, KERRI RENE (FNP-C)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:RENE
Last Name:DEXTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:R
Other - Last Name:TIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:2708 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3021
Practice Address - Country:US
Practice Address - Phone:765-449-1555
Practice Address - Fax:765-449-1110
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28206402A163W00000X
IN71009442A363LC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28206402AOtherRN LICENSE