Provider Demographics
NPI:1972154961
Name:BAIR, KERI
Entity type:Individual
Prefix:MISS
First Name:KERI
Middle Name:
Last Name:BAIR
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 1:6205 BLANKENBERGE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6058
Mailing Address - Country:US
Mailing Address - Phone:361-249-7135
Mailing Address - Fax:
Practice Address - Street 1:6205 BLANKENBERGE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6058
Practice Address - Country:US
Practice Address - Phone:361-249-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
TX121450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist