1013525187 NPI number — KERSHAW PRIMARY CARE AND WEIGHT LOSS, LLC

Table of content: (NPI 1013525187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013525187 NPI number — KERSHAW PRIMARY CARE AND WEIGHT LOSS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERSHAW PRIMARY CARE AND WEIGHT LOSS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013525187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 752102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38175-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-607-1292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6005 PARK AVE STE 826B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-5223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-519-4680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KERSHAW-BERRY
Authorized Official First Name:
VALARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OVER/NURSE PRACTITIONER
Authorized Official Telephone Number:
662-902-9883

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com