Healthcare Provider Details

I. General information

NPI: 1144577768
Provider Name (Legal Business Name): KRISHNA KOTHARY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD ST
CARRBORO NC
27510-1823
US

IV. Provider business mailing address

301 LLOYD ST
CARRBORO NC
27510-1823
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-1473
  • Fax:
Mailing address:
  • Phone: 919-942-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106073
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number124382
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005150
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5010747
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: