Dr. Kenneth J. Detrick M.D. - Psychiatry Physician in Winston Salem, North Carolina | ProviderWire

Full Name

Dr. Kenneth John Detrick M.D.

NPI Number

1023265956

NPI Type

Individual Provider

Gender

Male

Enumeration Date

08/21/2008

Specialties

(Taxonomies)

Name

Psychiatry Physician

Code

2084P0800X

Primary Taxonomy

Yes

Licenses

State

North Carolina

License Number

9500884

Contact
Information

Purpose

Mailing

Location

Address

159 KESWICK DR

190 KIMEL PARK DR

City

Advance

Winston Salem

State

NC

NC

Postal Code

27006-7271

27103-6946

Country

US

US

Telephone Number

(336) 998-0638

(336) 768-3296

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/21/2008

Provider Address

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