Healthcare Provider Details

I. General information

NPI: 1194385823
Provider Name (Legal Business Name): KATIE M HYATT AG-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 09/16/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER SUITE 411 CONE HEALTH NEUROSURGERY
GREENSBORO NC
27401
US

IV. Provider business mailing address

3322 WATAUGA DR
GREENSBORO NC
27410
US

V. Phone/Fax

Practice location:
  • Phone: 336-232-3210
  • Fax: 336-890-5523
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5011918
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number238701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: