Doctor Name: | KASEY LEE GENTRY |
NPI Number: | 1245614700 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 227834 |
Business Practice Address: | 600 Chatham Medical Park Elkin, NC - 286212482 |
Business Phone Number: | 3368354819 |
Business Fax Number: | |
Mailing Address: | 600 Chatham Medical Park, ELKIN |
State: | NC |
Postal Code: | 286212482 |
Phone Number: | 3368354819 |
Fax Number: | |
NPI Enumeration Date: | 07/15/2015 |
NPI Last Update Date: | 07/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 227834 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |