Provider Demographics
NPI:1033195144
Name:KENYON, ERIK L (DO)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:L
Last Name:KENYON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3601
Mailing Address - Country:US
Mailing Address - Phone:910-914-0540
Mailing Address - Fax:910-914-0640
Practice Address - Street 1:333 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3601
Practice Address - Country:US
Practice Address - Phone:910-914-0540
Practice Address - Fax:910-914-0640
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800591207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911444Medicaid
NC8911444Medicaid
G70377Medicare UPIN
NC2253736AMedicare ID - Type Unspecified