Provider Demographics
NPI:1750357075
Name:FOX, KERRY F (PA)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:F
Last Name:FOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8593
Mailing Address - Country:US
Mailing Address - Phone:336-356-2600
Mailing Address - Fax:336-356-2601
Practice Address - Street 1:202 SCENIC DR
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9418
Practice Address - Country:US
Practice Address - Phone:336-985-0625
Practice Address - Fax:336-985-2674
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P48804Medicare UPIN