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General NPI Number Information
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NPI Number | 1174183578
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Entity Type | Individual
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Provider Name | KERRI RUDDELL NP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 502 E AMENDE DR
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City | ODESSA
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State | WA
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Zip | 99159-7003
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Country | US
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Telephone | 509-982-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 3665 W EVERGREEN DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9018
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Country | US
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Telephone | 208-790-5191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 61858
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61469089
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP61858
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License Number State | ID
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