Healthcare Provider Details

I. General information

NPI: 1639498199
Provider Name (Legal Business Name): KATHARINE T. HARRELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE JANE THOMPSON

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 BEN FRANKLIN BLVD
DURHAM NC
27704-2147
US

IV. Provider business mailing address

PO BOX 601114
CHARLOTTE NC
28260-1114
US

V. Phone/Fax

Practice location:
  • Phone: 919-477-0047
  • Fax:
Mailing address:
  • Phone: 919-477-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number189076
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: