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General NPI Number Information
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NPI Number | 1790424927
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Entity Type | Individual
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Provider Name | PEGGY KERR PERM MAKEUP ARTIST
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Gender | Female
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Dates
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Enumeration Date | 06/04/2022
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Last Update Date | 06/04/2022
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Provider Practice Location Address
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Address Line | 6703 14TH ST W STE 203
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City | BRADENTON
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State | FL
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Zip | 34207-5837
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Country | US
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Telephone | 941-755-9960
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Fax |
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Provider Business Mailing Address
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Address Line | 4812 MIRAMAR DR UNIT 3205
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-3394
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Country | US
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Telephone | 484-354-6014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 52-44-2349786
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License Number State | FL
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