Basic Information
| Provider Information | |||||||||
| NPI: | 1295225084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOREY | ||||||||
| FirstName: | KERI | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 958 TAHOE ISLAND DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH LAKE TAHOE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961504217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493783785 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 RYLAND ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825640 | ||||||||
| FaxNumber: | 7759825641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2018 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN002958 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 236209 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.