MEDICARE: MS. SHERRY OUTLAND KENT FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	201315	NC
2	363LF0000X	Family Nurse Practitioner	201315	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2807373A	OTHER	NC	MEDICARE ID - TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205812799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRY OUTLAND KENT FNP

Provider Business Mailing Address
First Line	:	407 LIVE OAK ST
Second Line	:
City	:	BEAUFORT
State	:	NC
Zip	:	28516-1939
Country	:	US
Telephone Number	:	252-728-2328
Fax Number	:	252-728-2628

Provider Business Practice Location Address
First Line	:	407 LIVE OAK ST
Second Line	:
City	:	BEAUFORT
State	:	NC
Zip	:	28516-1939
Country	:	US
Telephone Number	:	252-728-2328
Fax Number	:	252-728-2628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	04/21/2008

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