Provider Demographics
NPI:1477620052
Name:MACDONALD, KERI WOLFE (BSN,MSN,FNP)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:WOLFE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:BSN,MSN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7746
Practice Address - Country:US
Practice Address - Phone:919-563-2896
Practice Address - Fax:919-563-2724
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCZF0000013Medicaid