Provider Demographics
NPI:1194166728
Name:WHALEY, KEREN ASHIE (NP)
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:ASHIE
Last Name:WHALEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 N DAVIDSON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1054
Mailing Address - Country:US
Mailing Address - Phone:980-621-6891
Mailing Address - Fax:
Practice Address - Street 1:3123 N DAVIDSON ST STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1054
Practice Address - Country:US
Practice Address - Phone:252-470-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC263822363LF0000X
GARN274795363LF0000X
NJ26NJ00578900363LF0000X
NC5006385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily