Healthcare Provider Details

I. General information

NPI: 1063643336
Provider Name (Legal Business Name): ERICA MICHELLE MCKEARNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5156 NC HIGHWAY 42 W
GARNER NC
27529-8417
US

IV. Provider business mailing address

5156 NC HIGHWAY 42 W
GARNER NC
27529-8417
US

V. Phone/Fax

Practice location:
  • Phone: 919-329-5000
  • Fax:
Mailing address:
  • Phone: 919-329-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3902000000
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03279
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: