Healthcare Provider Details

I. General information

NPI: 1386606275
Provider Name (Legal Business Name): STEPHEN P KIKEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 US HIGHWAY 158 W
YANCEYVILLE NC
27379-8304
US

IV. Provider business mailing address

439 US HIGHWAY 158 W
YANCEYVILLE NC
27379-8304
US

V. Phone/Fax

Practice location:
  • Phone: 336-694-9331
  • Fax: 336-694-4209
Mailing address:
  • Phone: 336-694-9331
  • Fax: 336-694-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38108
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: