Individual
DR. KERRITH LYN JAECKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14215 BALLANTYNE CORPORATE PL, SUITE 130, CHARLOTTE, NC 28277-3671
(704) 384-1950
(704) 384-1955
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1950
(704) 384-1955
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
9700294
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891050R
—
NC
05
—
N00295
—
SC
Enumeration date
04/03/2006
Last updated
03/07/2023
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