Provider Demographics
NPI:1992965727
Name:SESSOMS, KASEY MICHELLE (BK SPECIALIST)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:MICHELLE
Last Name:SESSOMS
Suffix:
Gender:F
Credentials:BK SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 FEGAN RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9788
Mailing Address - Country:US
Mailing Address - Phone:336-312-8557
Mailing Address - Fax:336-294-6696
Practice Address - Street 1:3511 W MARKET ST # B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4443
Practice Address - Country:US
Practice Address - Phone:336-294-3338
Practice Address - Fax:336-294-6696
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8200082KMedicaid