MR. KENNETH DOUGLAS LAKE (NPI# 1518981927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518981927 |
| Entity Type | Individual |
| Full Name | MR. KENNETH DOUGLAS LAKE |
| Credential | PA-C |
| Practice Address |
300 Mack Rd Asheboro NC 27205-1066 |
| Mailing Address |
Po Box 2005 Asheboro NC 27204-2005 |
| Practice Telephone | 3366251172 |
| Practice Fax Number | 3366256434 |
| Mailing Telephone | 3366251172 |
| Mailing Fax Number | 3366256434 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-02-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 101208 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1518981927 | 05 | |
| NC | BCBS NC | 1582K | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6215 Us Highway 64 E, Ramseur, NC 273168860 | 3368242551 | 3368242553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003964024 | Kenneth B Lake | Nurse Anesthetist, Certified Registered | 9961 Sierra Ave, Fontana, CA 92335-6720 | 2007-01-08 |
| Street Address |
300 MACK RD |
| City | ASHEBORO |
| State | NC |
| Zip Code | 27205-1066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184230401 | Jacqueline Elizabeth King | Nurse Practitioner | 300 Mack Rd, Asheboro, NC 27205-1066 | 2020-09-22 |
| 1538628656 | Chelsea Rice Poe | Nurse Practitioner | 300 Mack Rd, Asheboro, NC 27205-1066 | 2019-03-18 |
| 1730516998 | Monica Nicole Bartorelli | Nurse Practitioner | 300 Mack Rd, Asheboro, NC 27205-1066 | 2013-10-02 |
| 1265773709 | Jenna Breanne Hedrick | Nurse Practitioner | 300 Mack Rd, Asheboro, NC 27205-1066 | 2013-03-08 |
| 1093033060 | Tara Graves Gunter | Nurse Practitioner | 300 Mack Rd, Asheboro, NC 27205-1066 | 2010-05-14 |
| 1013082288 | Susan A Fuller | Nurse Practitioner | 300 Mack Rd, Asheboro, NC 27205-1066 | 2006-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003208349 | Marva Price | Nurse Practitioner | 2222 South Fayetteville Street, Randolph County Health Department, Asheboro, NC 27205 | 2015-02-24 |
| 1982948386 | Sara Ann Coponen | Counselor | 4539 Cross Creek Rd, Asheboro, NC 27205 | 2012-11-26 |
| 1104151729 | Holly Marie O'grady Vanbencoten | Physician Assistant | 1714 Back Creek Ct, Asheboro, NC 27205 | 2009-10-15 |
| 1306060280 | Harmon Physical Therapy, Inc | Clinic/Center | 304 Lanier Avenue, Asheboro, NC 27205 | 2007-04-12 |
| 1932154408 | Behavioral Associates of Asheboro | Counselor | 547 N. Fayettevillie Street, Asheboro, NC 27205 | 2006-05-23 |
| 1487120614 | Dallas Welborn Hurley | Nurse Practitioner | 2222 S Fayetteville St Ste B, Asheboro, NC 27205 | 2018-10-15 |
| 1134356819 | Monarch | Community/Behavioral Health | 837 Oakwood Acres Rd, Asheboro, NC 27205-0910 | 2009-06-19 |
| 1457644791 | Jakia Danielle Marshall | Counselor | 987 Redwood Dr, Asheboro, NC 27205-0926 | 2011-05-19 |
| 1851836662 | Manashi C-lim Therapy Services, Pllc. | Occupational Therapist | 2168 S Lake Dr, Asheboro, NC 27205-1053 | 2017-01-03 |
| 1700310984 | Manashi C-lim Therapy Services, Pllc. | Occupational Therapist | 2168 S Lake Dr, Asheboro, NC 27205-1053 | 2017-04-14 |
| Find all providers in zip 27205 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932651452 | Joshua Knight | Physician Assistant | 197 Nc-42, Asheboro, NC 27203 | 2016-11-01 |
| 1053862391 | Jamie Lauren Webb | Physician Assistant | 197 North Carolina 42 East, White Oak Urgent Care, Asheboro, NC 27203 | 2016-10-21 |
| 1922416593 | Kate Hoyt Yates | Physician Assistant | 600 W Salisbury St Ste B, Asheboro, NC 27203-5591 | 2014-07-28 |
| 1760604730 | Amy Jean Kearns | Physician Assistant | 223 West Ward Street, Asheboro, NC 27203-5423 | 2007-05-02 |
| 1578784005 | Kelli Ann Mosher | Physician Assistant | 713-b S Fayetteville Street, Asheboro, NC 27203 | 2007-05-01 |
| 1720137995 | Sara R Davis | Physician Assistant | 350 N Cox St Ste 27, Asheboro, NC 27203-5514 | 2007-01-09 |
| 1811007834 | William J. Stein | Physician Assistant | 610 N Fayetteville St Ste 202, Asheboro, NC 27203-4671 | 2006-08-30 |
| 1902876956 | Lloyd William Hickman Ix | Physician Assistant | 138-a Dublin Square Road, Asheboro, NC 27203 | 2006-01-24 |
| 1154301851 | Ronald Langston Estes | Physician Assistant | 138 Dublin Square Rd, A, Asheboro, NC 27203-8627 | 2006-01-19 |
| 1285295006 | Kimberly Underkoffler | Physician Assistant | 610 N Fayetteville St Ste 202, Asheboro, NC 27203-4671 | 2019-06-24 |
| Find all providers in ASHEBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.