Provider Demographics
NPI:1255950119
Name:DAMISH-KEMP, ALEXIS (DO)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:DAMISH-KEMP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3825
Mailing Address - Country:US
Mailing Address - Phone:508-631-6793
Mailing Address - Fax:
Practice Address - Street 1:110 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3825
Practice Address - Country:US
Practice Address - Phone:508-631-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT020005207V00000X
PA390200000X207V00000X
390200000X
NC2023-03178207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program