1720636038 NPI number — KATHERINE PRICE SUTHERLAND FNP-C

Table of content: KATHERINE PRICE SUTHERLAND FNP-C (NPI 1720636038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720636038 NPI number — KATHERINE PRICE SUTHERLAND FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTHERLAND
Provider First Name:
KATHERINE
Provider Middle Name:
PRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRICE
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
GLYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720636038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 986513
Provider Second Line Business Mailing Address:
DEPT 100
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02298-6513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-219-8326
Provider Business Mailing Address Fax Number:
910-939-4269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114A MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-6328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-353-0700
Provider Business Practice Location Address Fax Number:
910-353-5305
Provider Enumeration Date:
08/29/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024178159 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 5014159 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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