Provider Demographics
NPI:1336393545
Name:PATRICK, KERI PEYTON (RN, LMT)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:PEYTON
Last Name:PATRICK
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 NW 25TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2273
Mailing Address - Country:US
Mailing Address - Phone:772-532-4382
Mailing Address - Fax:
Practice Address - Street 1:5127 NW 39TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5943
Practice Address - Country:US
Practice Address - Phone:352-271-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54232225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist