Healthcare Provider Details

I. General information

NPI: 1952752743
Provider Name (Legal Business Name): MISS KERI NEWBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KERI LYNN BODEN

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 E TONTO DR
DEWEY AZ
86327-6916
US

IV. Provider business mailing address

9835 E TONTO DR
DEWEY AZ
86327-6916
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-5331
  • Fax: 928-910-2090
Mailing address:
  • Phone: 928-632-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberD01309813
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberD01309813
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: