Healthcare Provider Details

I. General information

NPI: 1699611285
Provider Name (Legal Business Name): RAH-KIMM KAURON CHERRY SR. BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7717 LOUETTA RD # 11167
SPRING TX
77379-7292
US

IV. Provider business mailing address

7717 LOUETTA RD # 11167
SPRING TX
77379-7292
US

V. Phone/Fax

Practice location:
  • Phone: 628-600-4409
  • Fax:
Mailing address:
  • Phone: 628-600-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95101214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: