Healthcare Provider Details

I. General information

NPI: 1194642603
Provider Name (Legal Business Name): KERI-ANN MCGONIGLE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 SEFORD DR
DURHAM NC
27703-2577
US

IV. Provider business mailing address

2023 SEFORD DR
DURHAM NC
27703-2577
US

V. Phone/Fax

Practice location:
  • Phone: 919-633-0086
  • Fax:
Mailing address:
  • Phone: 919-633-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number324117
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: