Provider Demographics
NPI:1598834350
Name:SMITH, KERRY ALLYSON (DPM)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ALLYSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:1604 PHYSICIANS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7362
Mailing Address - Country:US
Mailing Address - Phone:910-777-9054
Mailing Address - Fax:910-550-2840
Practice Address - Street 1:1604 PHYSICIANS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7362
Practice Address - Country:US
Practice Address - Phone:910-777-9054
Practice Address - Fax:910-550-2840
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2015-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC509213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery