Provider Demographics
NPI:1033698683
Name:ARTIS, KERON TERRELL
Entity Type:Individual
Prefix:MR
First Name:KERON
Middle Name:TERRELL
Last Name:ARTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CHESNEE DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1523
Mailing Address - Country:US
Mailing Address - Phone:252-544-2600
Mailing Address - Fax:
Practice Address - Street 1:1405 CHESNEE DR NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1523
Practice Address - Country:US
Practice Address - Phone:252-544-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health