Basic Information
| Provider Information | |||||||||
| NPI: | 1205959921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDRIDGE | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | CNM, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14629 BLACKBERRY LN | ||||||||
| Address2: | |||||||||
| City: | FOREST RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959429773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308939571 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2767 OLIVE HWY | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 05/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 1668 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.