Provider Demographics
NPI:1164815908
Name:KEARNEY, PAULA (LAC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 CENTRAL AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5080
Mailing Address - Country:US
Mailing Address - Phone:704-770-1318
Mailing Address - Fax:
Practice Address - Street 1:1318 CENTRAL AVE STE A3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5080
Practice Address - Country:US
Practice Address - Phone:704-770-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-827171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist