Provider Demographics
NPI:1295737963
Name:BARROW, KERN LEE (PA)
Entity type:Individual
Prefix:
First Name:KERN
Middle Name:LEE
Last Name:BARROW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-285-0333
Mailing Address - Fax:910-285-0336
Practice Address - Street 1:112 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE G
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1665
Practice Address - Country:US
Practice Address - Phone:910-285-0333
Practice Address - Fax:910-285-0336
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102509363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1295737963Medicaid
NCP00414499OtherRAIL ROAD MEDICARE
SC1329PAMedicaid
NC8101670Medicaid
NCS60466Medicare UPIN
NC1295737963Medicaid
SC1329PAMedicaid
NCNC0341CMedicare PIN
NC2748267SMedicare PIN