Provider Demographics
NPI:1629230263
Name:MUSICK, KERRY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LYNN
Last Name:MUSICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:136 FAIRVIEW RD STE 125
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8547
Mailing Address - Country:US
Mailing Address - Phone:704-677-7635
Mailing Address - Fax:980-435-0398
Practice Address - Street 1:136 FAIRVIEW RD STE 125
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8547
Practice Address - Country:US
Practice Address - Phone:704-677-7635
Practice Address - Fax:980-435-0398
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV248612084P0800X
NC2015-020112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629230263Medicaid
NCNCS392AMedicare PIN