Provider Demographics
NPI:1518003086
Name:KEARNS, LISA KELLY (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KELLY
Last Name:KEARNS
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2218
Mailing Address - Country:US
Mailing Address - Phone:252-342-2907
Mailing Address - Fax:252-726-1458
Practice Address - Street 1:2320 SHORE DR.
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-342-2907
Practice Address - Fax:252-726-1458
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1355HOtherBCBS NCHEALTHCHOICE ID
NC7412045Medicaid