MEDICARE: JERMAINE KEARNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		NC
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083335434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERMAINE KEARNEY

Provider Business Mailing Address
First Line	:	4100 TENSITY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5455
Country	:	US
Telephone Number	:	919-740-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 TENSITY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5455
Country	:	US
Telephone Number	:	919-740-0142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

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Directions to “ JERMAINE KEARNEY ” Practice Location

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