Healthcare Provider Details

I. General information

NPI: 1952696528
Provider Name (Legal Business Name): KERRY DEWITT SHEPHERD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 01/29/2021
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RESORT DR
ASHEVILLE NC
28806-3815
US

IV. Provider business mailing address

1 RESORT DRIVE MOUNTAIN SLEEP OFFICE
ASHEVILLE NC
28806-3815
US

V. Phone/Fax

Practice location:
  • Phone: 828-350-1773
  • Fax:
Mailing address:
  • Phone: 828-350-1773
  • Fax: 828-350-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07573
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: