MEDICARE: MS. KERRI R PAKURAR BCBA

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	103K00000X	Behavior Analyst	1-08-4808	SC

General Provider Information

NPI Number	:	1336380054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRI R PAKURAR BCBA

Provider Business Mailing Address
First Line	:	828 WAPPOO RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5865
Country	:	US
Telephone Number	:	843-297-8470
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 WAPPOO RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5865
Country	:	US
Telephone Number	:	843-297-8470
Fax Number	:

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

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	04/18/2017

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