Provider Demographics
NPI:1134576556
Name:PRATT, KERI BETH
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:BETH
Last Name:PRATT
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 1:24 FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14105-1353
Mailing Address - Country:US
Mailing Address - Phone:716-572-1566
Mailing Address - Fax:
Practice Address - Street 1:24 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-1353
Practice Address - Country:US
Practice Address - Phone:716-572-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist