Provider Demographics
NPI:1417695057
Name:COLE, KEREON M
Entity Type:Individual
Prefix:
First Name:KEREON
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6742
Mailing Address - Country:US
Mailing Address - Phone:352-629-1940
Mailing Address - Fax:
Practice Address - Street 1:948 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6742
Practice Address - Country:US
Practice Address - Phone:352-629-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician