Basic Information
| Provider Information | |||||||||
| NPI: | 1316990377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 733 21ST AVE NE | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286011562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284438177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2201 S STERLING ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286554044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285805000 | ||||||||
| FaxNumber: | 3367250454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 7153 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1416X | 01 | NC | NC BCBS | OTHER | 7412525 | 05 | NC | MEDICAID |