DR. KENNETH JOHN DETRICK (NPI# 1023265956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023265956 |
| Entity Type | Individual |
| Full Name | DR. KENNETH JOHN DETRICK |
| Credential | M.D. |
| Practice Address |
190 Kimel Park Dr Winston Salem NC 27103-6946 |
| Mailing Address |
159 Keswick Dr Advance NC 27006-7271 |
| Practice Telephone | 3367683296 |
| Mailing Telephone | 3369980638 |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-08-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
9500884 | NC | Allopathic & Osteopathic Physicians |
| Street Address |
190 KIMEL PARK DR |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-6946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073863197 | Department of Veterans Affairs | General Acute Care Hospital | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2012-09-17 |
| 1770847188 | Tracy Maria Powers | Registered Nurse | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2012-06-29 |
| 1891926101 | Leslie Paul Schellbach | Social Worker | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2009-08-04 |
| 1750532180 | Edward V. Spudis | Clinic/Center | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2008-10-03 |
| 1093984007 | Jennifer Lynn Herb | Counselor | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2008-02-23 |
| 1790969277 | William R Bodner | Psychiatry & Neurology | 190 Kimel Park Dr, C&p Unit, Winston Salem, NC 27103-6946 | 2007-12-20 |
| 1215111828 | Carey Vastine Stabler | General Practice | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2007-12-19 |
| 1023216199 | Ahunna N Okwubunka-anyim | Family Medicine | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2007-07-10 |
| 1518162460 | Chetan Desai | Internal Medicine | 190 Kimel Park Dr, Va Out-patient Clinic, Winston Salem, NC 27103-6946 | 2007-06-20 |
| 1093770158 | Deborah Lewis Cranfill | Pharmacist | 190 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2006-04-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609317569 | Certus Psychiatry and Integrated Care Pllc | Psychiatry & Neurology | 1255 Creekshire Way, Suite 270, Winston Salem, NC 27103-3059 | 2017-03-12 |
| 1982142550 | Susmita Hazarika | Psychiatry & Neurology | 5092 Nottingham Place Ln, Apt 202, Winston Salem, NC 27106-4690 | 2017-02-03 |
| 1396165056 | Poonam Deshmukh | Psychiatry & Neurology | Wake Forest Medical Center Medical Center Blvd, Winston Salem, NC 27157-0001 | 2014-04-21 |
| 1912340324 | Derek Ayers | Psychiatry & Neurology | Medical Ceneter Blvd, Winston Salem, NC 27157-0001 | 2013-04-16 |
| 1427319698 | Jacquetta Melony Foushee | Psychiatry & Neurology | 140 Kimel Park Dr # 200, Winston Salem, NC 27103-6160 | 2012-06-05 |
| 1972737922 | Tayyba G Buttar | Psychiatry & Neurology | 3736 Old Vineyard Rd, Old Vineyard Behavioral Health Services, Winston Salem, NC 27284 | 2009-05-05 |
| 1912114513 | William Thomas Harris | Psychiatry & Neurology | 1010 W Northwest Blvd, Winston Salem, NC 27101-1105 | 2007-05-16 |
| 1093856395 | Barbara Ballow Lankton | Psychiatry & Neurology | 1066 West Fourth St, Winston Salem, NC 27101-2434 | 2007-02-09 |
| 1699828475 | Ashleybrook Clinic Pa | Psychiatry & Neurology | 1321 Ashleybrook Lane, Winston Salem, NC 27103-2918 | 2007-01-18 |
| 1205946050 | Lea Harrell Kirkland | Psychiatry & Neurology | 2990 Bethesda Place, Suite 601-a, Winston Salem, NC 27103 | 2006-08-30 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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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.