Provider Demographics
NPI:1366727497
Name:SQUITTIERI, KERI ANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANNE
Last Name:SQUITTIERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17039 KENTON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5776
Mailing Address - Country:US
Mailing Address - Phone:704-596-1787
Mailing Address - Fax:704-596-6230
Practice Address - Street 1:3006 BAUCOM RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6762
Practice Address - Country:US
Practice Address - Phone:704-596-1787
Practice Address - Fax:704-596-6230
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03191363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical