MEDICARE: KERN LEE BARROW PA

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	363A00000X	Physician Assistant	102509	NC
2	363AM0700X	Medical Physician Assistant	102509	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00414499	OTHER	NC	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295737963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERN LEE BARROW PA

Provider Business Mailing Address
First Line	:	PO BOX 602484
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2484
Country	:	US
Telephone Number	:	910-285-0333
Fax Number	:	910-285-0336

Provider Business Practice Location Address
First Line	:	112 MEDICAL VILLAGE DR
Second Line	:	SUITE G
City	:	WALLACE
State	:	NC
Zip	:	28466-1665
Country	:	US
Telephone Number	:	910-285-0333
Fax Number	:	910-285-0336

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/30/2016

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Directions to “ KERN LEE BARROW PA” Practice Location

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