Provider Demographics
NPI:1528050044
Name:KERKERING, KATHRYN W (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:W
Last Name:KERKERING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 GROVE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-3390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 S JEFFERSON ST STE 201
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4418
Practice Address - Country:US
Practice Address - Phone:540-224-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002015962080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00002731OtherRAILROAD MEDICARE
NC1329WOtherBCBS NC
NC891329WMedicaid
NC1329WOtherBCBS NC
NCP00002731OtherRAILROAD MEDICARE