Healthcare Provider Details

I. General information

NPI: 1710824966
Provider Name (Legal Business Name): KERRI SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

43 TOPSAIL ISLAND DR
GARNER NC
27529-6135
US

IV. Provider business mailing address

43 TOPSAIL ISLAND DR
GARNER NC
27529-6135
US

V. Phone/Fax

Practice location:
  • Phone: 919-452-7952
  • Fax:
Mailing address:
  • Phone: 919-452-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number314674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: