Healthcare Provider Details

I. General information

NPI: 1598834350
Provider Name (Legal Business Name): KERRY ALLYSON SMITH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 PHYSICIANS DR SUITE 105
WILMINGTON NC
28401-7362
US

IV. Provider business mailing address

1604 PHYSICIANS DR SUITE 105
WILMINGTON NC
28401-7362
US

V. Phone/Fax

Practice location:
  • Phone: 910-777-9054
  • Fax: 910-550-2840
Mailing address:
  • Phone: 910-777-9054
  • Fax: 910-550-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number509
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: