Provider Demographics
NPI:1710402904
Name:KERRY L. MUSICK, MD, PLLC
Entity Type:Organization
Organization Name:KERRY L. MUSICK, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-651-3156
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:704-651-3156
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty