Kern Lee Barrow, PA
Individual provider Active NPI Physician Assistant · Wallace, NC
NPI 1295737963 · NPPES record last updated Dec 30, 2016
Key facts
- NPI
- 1295737963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 102509 (NC)
- Practice address
- 112 Medical Village Dr
Suite G
Wallace, NC 28466-1665 - Phone
- (910) 285-0333
- Fax
- (910) 285-0336
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050207000485 | NC | Practitioner - Physician Assistant | 8022069145 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102509 | NC | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbus Regional Health Network | Past | Accepting new patients | |
| Northeastern Orthopedics, PA | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 102509 | NC | Yes |
| Medical Physician Assistant | 363AM0700X | 102509 | NC |
Addresses
Primary practice location
112 Medical Village Dr
Suite G
Wallace, NC 28466-1665
Mailing address
PO Box 602484
Charlotte, NC 28260-2484
Phone (910) 285-0333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295737963 | Medicaid | NC | |
| P00414499 | Other | NC | RAIL ROAD MEDICARE |
| 1329PA | Medicaid | SC | |
| 8101670 | Medicaid | NC |
Other providers in Wallace, NC
- A Darren Sholar, DDS,PA
- A Time of Refreshing Salon and Day Spa, LLC
- Sarah Anderson
- Corey Ryan Ayers
- Amy Bannerman
- Jean Kelly Bish
- Blair Family Medicine
- Mott Parks Blair IV
- Joseph Bologna
- Angela Boney
All providers in Wallace, NC · Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.