Matthew John Kesic, PHD, PA-S2

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

217 Main Street
Buies Creek, NC 27506

Phone

(910) 893-1690

NPI assigned

Apr 10, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant, Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586476800000",
    "number": "1235758202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2536 HEATHCOTE LN",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275028518",
            "telephone_number": "919-607-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 MAIN STREET",
            "city": "BUIES CREEK",
            "state": "NC",
            "postal_code": "27506",
            "telephone_number": "910-893-1690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESIC",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "credential": "PHD, PA-S2",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-10",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelia Glenn, RN
• Abigail R Harrison, MS, LAT, ATC
• Alissa Hennen
• Angela C. Holland, R.N.
• Betty Lynne Johnson, PA-C
• Dawn Alicia Kuch
• Jessica Lail Libicer, PA-S
• Nichole A. Lilly
• Lobsang Lobsang
• Nicole Lopez

• Student in an Organized Health Care Education/Training Program in Buies Creek, NC
• Providers in Buies Creek, NC by specialty
• Student in an Organized Health Care Education/Training Program in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.