Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | 5010246 | NC |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5010246 | NC |
NPI | 1023519543 |
---|---|
Provider Name | Mrs. Julie Renee Kerth |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2018 |
Last Update Date | 17/03/2018 |