Provider Demographics
NPI:1790424927
Name:KERR, PEGGY (PERM MAKEUP ARTIST)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:PERM MAKEUP ARTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 MIRAMAR DR UNIT 3205
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3394
Mailing Address - Country:US
Mailing Address - Phone:484-354-6014
Mailing Address - Fax:
Practice Address - Street 1:6703 14TH ST W STE 203
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5837
Practice Address - Country:US
Practice Address - Phone:941-755-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL52-44-23497862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty