Secret Guru Permanent Makeup

Primary specialty

Medical Art Specialist/TechnologistTaxonomy code 246ZA2600X

Legal business name

SECRET GURU PERMANENT MAKEUP

Practice address

587 Southlake Blvd Ste a
North Chesterfield, VA 23236-3096

Phone

(804) 895-7616

NPI assigned

Jan 24, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christina Southers, MASTERS BOARD CERT.NPI 1255047270

Title

Owner

Phone

(804) 615-7476

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christina Southers, MASTERS BOARD CERT.

  • Medical Art Specialist/Technologist
  • North Chesterfield, VA
  • NPI 1255047270

  Art, Medical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1033825062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3511 BELLBLUFF DR",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232371002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 SOUTHLAKE BLVD STE A",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363096",
            "telephone_number": "804-895-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECRET GURU PERMANENT MAKEUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "SOUTHERS",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-615-7476",
        "authorized_official_credential": "MASTERS BOARD CERT."
    },
    "taxonomies": [
        {
            "code": "246ZA2600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Art, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Art Specialist/Technologist in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Medical Art Specialist/Technologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.