Healthcare Provider Details

I. General information

NPI: 1831647510
Provider Name (Legal Business Name): KATHRYN HAZEL WHITEHEAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

IV. Provider business mailing address

490 HOSPITAL DR
CLYDE NC
28721-8026
US

V. Phone/Fax

Practice location:
  • Phone: 828-246-6372
  • Fax: 828-246-6371
Mailing address:
  • Phone: 828-246-6372
  • Fax: 828-246-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16685
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60703191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: