St Petersburg Skin and Laser Center LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ST PETERSBURG SKIN AND LASER CENTER LLC

Practice address

100 40TH Ave N
St Petersburg, FL 33703-6125

Phone

(727) 474-9399

Fax

(202) 436-9358

NPI assigned

Jan 2, 2020

Last updated

May 28, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Katarina R Kesty, MDNPI 1396126744

Title

Physician

Phone

(727) 474-4938

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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.

• Katarina Rose Kesty, M.D.

  • Dermatology Physician
  • St Petersburg, FL
  • NPI 1396126744
  Medicare reassignment Care Compare group NPD Authorized official
• Chelsea Kesty, MD

  • Dermatology Physician
  • St Petersburg, FL
  • NPI 1417419342
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1205475761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 40TH AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337036125",
            "telephone_number": "727-474-9399",
            "fax_number": "202-436-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 40TH AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337036125",
            "telephone_number": "727-474-9399",
            "fax_number": "202-436-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETERSBURG SKIN AND LASER CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "KESTY",
        "authorized_official_first_name": "KATARINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "727-474-4938",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Petersburg Maternal Fetal Medicine Associates
• St Petersburg Medical Center LLC
• St Petersburg Nursing and Rehab Opco LLC (Vivo Healthcare St Petersburg)
• St Petersburg Pain & Urgent Care
• St Petersburg Psychotherapy, LLC
• St Petersburg SNF Operations LLC
• St Petersburg Surgery Center LTD
• St Petersburg Uscg Phcy
• St. Anthony's Professional Buildings & Services, Inc
• St. Anthony's Professional Buildings & Services, Inc (BayCare Outpatient Imaging)

• Dermatology Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.