Kinston Dermatology, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

84026 Issued in NC

Legal business name

KINSTON DERMATOLOGY, PA

Practice address

701 Doctors Dr
Kinston Clinic North, Suite F
Kinston, NC 28501-1584

Phone

(252) 523-3289

Fax

(252) 523-1310

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Diana Monroe Henshaw, EDD

Title

Secretary/Treasurer

Phone

(252) 523-3289

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristine Jane Kucera, PA

  • Physician Assistant
  • Melissa, TX
  • NPI 1699970368
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508976432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 DOCTORS DR",
            "address_2": "KINSTON CLINIC NORTH, SUITE F",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285011584",
            "telephone_number": "252-523-3289",
            "fax_number": "252-523-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DOCTORS DR",
            "address_2": "KINSTON CLINIC NORTH, SUITE F",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285011584",
            "telephone_number": "252-523-3289",
            "fax_number": "252-523-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINSTON DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENSHAW",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "MONROE",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "252-523-3289",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "84026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0105H",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790105H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kinston Community Health Center, Inc
• Kinston Community Health Center, Inc
• Kinston Community Health Center, Inc (Kinston Community Pharmacy)
• Kinston Community Health Center, Inc
• Kinston Community Health Center, Inc.
• Kinston Diagnostic Group PA
• Kinston Digestive Diseases PA
• Kinston Head and Neck Physicians and Surgeons, P.a.
• Kinston Internal Medicine & Geriatrics
• Kinston Medical Specialists PA

• Specialist in Kinston, NC
• Providers in Kinston, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.