Provider Demographics
NPI:1366744708
Name:KERRY, DONNA WETZEL (NP-C)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:WETZEL
Last Name:KERRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:WETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1660 S STAPLES ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3173
Mailing Address - Country:US
Mailing Address - Phone:361-800-8155
Mailing Address - Fax:361-882-2590
Practice Address - Street 1:1660 S STAPLES ST
Practice Address - Street 2:STE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3173
Practice Address - Country:US
Practice Address - Phone:361-800-8155
Practice Address - Fax:361-882-2590
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX396630YLPSOtherWNI PTAN
TX348993201Medicaid