Healthcare Provider Details

I. General information

NPI: 1841281888
Provider Name (Legal Business Name): MS. KATHLEEN T FOULK
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 JABARA AVE SEYMOUR JOHNSON AFB
GOLDSBORO NC
27531-2310
US

IV. Provider business mailing address

1050 JABARA AVE SEYMOUR JOHNSON AFB
GOLDSBORO NC
27531-2310
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-0928
  • Fax: 919-722-1952
Mailing address:
  • Phone: 919-722-0928
  • Fax: 919-722-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number303173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: