Provider Demographics
NPI:1063518165
Name:BALENTINE, KERRY LAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LAYNE
Last Name:BALENTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:LAYNE
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:418 S. WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150
Mailing Address - Country:US
Mailing Address - Phone:704-692-9380
Mailing Address - Fax:833-605-5203
Practice Address - Street 1:418 S. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-692-9380
Practice Address - Fax:833-605-5203
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-005142084P0800X
VA0101235062103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry