Healthcare Provider Details

I. General information

NPI: 1699641308
Provider Name (Legal Business Name): KERI CHERELLE WAITERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 STEWART PLACE RD
HEATH SPRINGS SC
29058-8880
US

IV. Provider business mailing address

4760 STEWART PLACE RD
HEATH SPRINGS SC
29058-8880
US

V. Phone/Fax

Practice location:
  • Phone: 803-577-5534
  • Fax:
Mailing address:
  • Phone: 803-577-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number6706
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6706
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: