MEDICARE: KERTRINA SURGEON

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1598608887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERTRINA SURGEON

Provider Business Mailing Address
First Line	:	6040 PROVIDENCE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-6822
Country	:	US
Telephone Number	:	704-713-2444
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 PROVIDENCE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-6822
Country	:	US
Telephone Number	:	704-713-2444
Fax Number	:

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

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/11/2026

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Directions to “ KERTRINA SURGEON ” Practice Location

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