Provider Demographics
NPI:1467462218
Name:KERSEY FAMILY CARE, PC
Entity Type:Organization
Organization Name:KERSEY FAMILY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:G
Authorized Official - Last Name:KERSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-609-2273
Mailing Address - Street 1:601 E GOVERNOR JOHN SEVIER HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6713
Mailing Address - Country:US
Mailing Address - Phone:865-609-2273
Mailing Address - Fax:865-609-9373
Practice Address - Street 1:601 E GOVERNOR JOHN SEVIER HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6713
Practice Address - Country:US
Practice Address - Phone:865-609-2273
Practice Address - Fax:865-609-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724903Medicare PIN
TN3724903Medicare ID - Type UnspecifiedFAMILY PRACTICE