Provider Demographics
NPI:1932298007
Name:BYRD, KERRY WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:WENDELL
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:99 GRIFFIN STREET
Mailing Address - Street 2:PO BOX 806
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0806
Mailing Address - Country:US
Mailing Address - Phone:828-874-1316
Mailing Address - Fax:828-874-1092
Practice Address - Street 1:99 GRIFFIN STREET
Practice Address - Street 2:
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671-0806
Practice Address - Country:US
Practice Address - Phone:828-874-1316
Practice Address - Fax:828-874-1092
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-12-28
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Provider Licenses
StateLicense IDTaxonomies
NC33797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920610Medicaid
NC2204675CMedicare PIN
NC8920610Medicaid