Healthcare Provider Details

I. General information

NPI: 1477469096
Provider Name (Legal Business Name): MALIK KERSEY MA, LPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 THINK SMART LN
ERWIN NC
28339-9123
US

IV. Provider business mailing address

1332 TRINITY RD
CARY NC
27513-6212
US

V. Phone/Fax

Practice location:
  • Phone: 910-514-9977
  • Fax:
Mailing address:
  • Phone: 919-454-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number7129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: