Basic Information
| Provider Information | |||||||||
| NPI: | 1669438891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEARNEY | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9589 VALENCIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280273535 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 137 OVERHILL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281178006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047996824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6779 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7412321 | 05 | NC | MEDICAID |