Provider Demographics
NPI:1518953504
Name:HERON, KERRIE-ANNE ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRIE-ANNE
Middle Name:ALEXANDRA
Last Name:HERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 NASH ST N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1232
Mailing Address - Country:US
Mailing Address - Phone:252-237-5237
Mailing Address - Fax:252-234-9932
Practice Address - Street 1:3302 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1232
Practice Address - Country:US
Practice Address - Phone:252-237-5237
Practice Address - Fax:252-234-9932
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2016-05-10
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
NC200300353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135H4Medicaid
NC2022516AMedicare PIN
NC89135H4Medicaid