Provider Demographics
NPI:1366243396
Name:PETRICK, KERRY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:PETRICK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 GRAND GRIFFON WAY
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-4312
Mailing Address - Country:US
Mailing Address - Phone:302-824-0354
Mailing Address - Fax:
Practice Address - Street 1:143 GRAND GRIFFON WAY
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-4312
Practice Address - Country:US
Practice Address - Phone:302-824-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC377153163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant