Healthcare Provider Details

I. General information

NPI: 1760604730
Provider Name (Legal Business Name): AMY JEAN KEARNS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WEST WARD STREET
ASHEBORO NC
27203-5423
US

IV. Provider business mailing address

752 MACK ROAD
ASHEBORO NC
27205
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: