Basic Information
| Provider Information | |||||||||
| NPI: | 1659737542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEARNS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 564 N PAGE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283874736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172836419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 APPLECROSS RD | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106928224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2016 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0010-06113 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.