Healthcare Provider Details

I. General information

NPI: 1992928576
Provider Name (Legal Business Name): KATHY WIKE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FOREST SERVICE DR MITCHELL COUNTY HEALTH DEPARTMENT
BAKERSVILLE NC
28705-7047
US

IV. Provider business mailing address

PO BOX 251
MONTEZUMA NC
28653-0251
US

V. Phone/Fax

Practice location:
  • Phone: 828-688-2371
  • Fax:
Mailing address:
  • Phone: 828-733-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number029
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: