Healthcare Provider Details

I. General information

NPI: 1295737963
Provider Name (Legal Business Name): KERN LEE BARROW PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MEDICAL VILLAGE DR SUITE G
WALLACE NC
28466-1665
US

IV. Provider business mailing address

PO BOX 602484
CHARLOTTE NC
28260-2484
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-0333
  • Fax: 910-285-0336
Mailing address:
  • Phone: 910-285-0333
  • Fax: 910-285-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102509
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102509
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: