Provider Demographics
NPI:1952696528
Name:SHEPHERD, KERRY DEWITT (PA-C)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DEWITT
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RESORT DRIVE
Mailing Address - Street 2:MOUNTAIN SLEEP OFFICE
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3815
Mailing Address - Country:US
Mailing Address - Phone:828-350-1773
Mailing Address - Fax:828-350-1774
Practice Address - Street 1:1 RESORT DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3815
Practice Address - Country:US
Practice Address - Phone:828-350-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC531171100000X
NC0010-07573363A00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No171100000XOther Service ProvidersAcupuncturist
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant