Provider Demographics
NPI:1013632207
Name:MCPHEETERS, KERRY MARIE
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MARIE
Last Name:MCPHEETERS
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 1:1655 PALM BEACH LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2203
Mailing Address - Country:US
Mailing Address - Phone:561-612-6000
Mailing Address - Fax:561-612-6001
Practice Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2203
Practice Address - Country:US
Practice Address - Phone:561-612-6000
Practice Address - Fax:561-612-6001
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS.0101026171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator