MEDICARE: KERRI KATHLEEN BENAVIDES LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	217619	TX

General Provider Information

NPI Number	:	1538769740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI KATHLEEN BENAVIDES LVN

Provider Business Mailing Address
First Line	:	PO BOX 42303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77242-2303
Country	:	US
Telephone Number	:	713-492-1705
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 WILCREST DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2753
Country	:	US
Telephone Number	:	713-666-8287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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