Healthcare Provider Details

I. General information

NPI: 1477358281
Provider Name (Legal Business Name): KAITLYN UZELAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2946 FLINTRIDGE DR
GREENVILLE NC
27834-4962
US

V. Phone/Fax

Practice location:
  • Phone: 252-816-3714
  • Fax:
Mailing address:
  • Phone: 412-551-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number5021687
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: