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Organization

IMAGINE PEDIATRICS OF NORTH CAROLINA, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENNETH TAYLOR BEERY (CHIEF ADMIN. OFFICER (CAO))
(504) 470-4140
Entity
Organization

Contact information

Practice address
506 RAMSEUR ST STE 1, DURHAM, NC 27701-4890
(833) 208-7770
Mailing address
220 ATHENS WAY # 240, NASHVILLE, TN 37228-1311
(833) 208-7770

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
106H00000X
Marriage & Family Therapist
133V00000X
Registered Dietitian
183500000X
Pharmacist
207R00000X
Internal Medicine Physician
208000000X
Pediatrics Physician
Primary
363L00000X
Nurse Practitioner
363LA2100X
Acute Care Nurse Practitioner
363LF0000X
Family Nurse Practitioner
363LP0200X
Pediatric Nurse Practitioner
363LP0222X
Critical Care Pediatric Nurse Practitioner

Other

Enumeration date
02/01/2024
Last updated
02/06/2024
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