Provider Demographics
NPI:1407536998
Name:DANIEL, KERRY A (FNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:DANIEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8110
Mailing Address - Country:US
Mailing Address - Phone:704-766-1000
Mailing Address - Fax:704-766-1002
Practice Address - Street 1:2554 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8110
Practice Address - Country:US
Practice Address - Phone:704-766-1000
Practice Address - Fax:704-766-1002
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily