Provider Demographics
NPI:1881370401
Name:MASON, KERRIE ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:ELIZABETH
Last Name:MASON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERRIE
Other - Middle Name:ELIZABETH
Other - Last Name:JUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1251 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4450
Mailing Address - Country:US
Mailing Address - Phone:910-822-6587
Mailing Address - Fax:
Practice Address - Street 1:1251 OLIVER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4450
Practice Address - Country:US
Practice Address - Phone:910-822-6587
Practice Address - Fax:910-426-6587
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018190363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner