Provider Demographics
NPI:1801198833
Name:MYATT, KERRI GENTILE (LOM, DIPLOM)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:GENTILE
Last Name:MYATT
Suffix:
Gender:F
Credentials:LOM, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 LEA DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8246
Mailing Address - Country:US
Mailing Address - Phone:610-308-4298
Mailing Address - Fax:
Practice Address - Street 1:864 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2516
Practice Address - Country:US
Practice Address - Phone:610-308-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist