Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 363LF0000X | Nurse Practitioner | Family | 201835 | NORTH CAROLINA | No |
| 2 | 111N00000X | Chiropractor | | 2394 | NORTH CAROLINA | No |
| 3 | 207R00000X | Internal Medicine | | 930076 | NORTH CAROLINA | No |
| 4 | 363LA2200X | Nurse Practitioner | Adult Health | 0050-02018 | NORTH CAROLINA | No |
| 5 | 207R00000X | Internal Medicine | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 5011967 | OTHER | NORTH CAROLINA | LICENSE # - KERNEY YU |
| 2 | 0010-04356 | OTHER | NORTH CAROLINA | LICENSE # - TYLER CASSIDY |
| 3 | 930076 | OTHER | NORTH CAROLINA | CARA L. DAVIS LICENSE |
| 4 | 2394 | OTHER | NORTH CAROLINA | G. GRUBER DC LICENSE # |
| 5 | 0050-02018 | OTHER | NORTH CAROLINA | J. CHARLES ANP LISCENSE |