Provider Demographics
NPI:1043830706
Name:JUNCO, KAYSIE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:KAYSIE
Middle Name:LYNN
Last Name:JUNCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BELLGROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2795
Mailing Address - Country:US
Mailing Address - Phone:386-852-7624
Mailing Address - Fax:
Practice Address - Street 1:160 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-5022
Practice Address - Country:US
Practice Address - Phone:919-966-4676
Practice Address - Fax:919-966-6718
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261780390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program