Healthcare Provider Details

I. General information

NPI: 1497303515
Provider Name (Legal Business Name): AMBER NICOLE KERR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14286 BEACH BLVD STE 19-222
JACKSONVILLE FL
32250-1561
US

IV. Provider business mailing address

11172 CAMPFIELD CIR
JACKSONVILLE FL
32256-3904
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-5061
  • Fax: 866-730-7983
Mailing address:
  • Phone: 678-360-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT872580
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: