Provider Demographics
NPI:1811869068
Name:HILBOURN, KERRI ANNE
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:HILBOURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 COUNTRY CLUB RD STE C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3749
Mailing Address - Country:US
Mailing Address - Phone:336-972-3673
Mailing Address - Fax:
Practice Address - Street 1:4712 COUNTRY CLUB RD STE C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3749
Practice Address - Country:US
Practice Address - Phone:336-972-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist