Healthcare Provider Details

I. General information

NPI: 1912208976
Provider Name (Legal Business Name): KATHRYN DAVIS VANNOY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EASTCHESTER DR STE 107
HIGH POINT NC
27265-3066
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2900
  • Fax: 336-802-2901
Mailing address:
  • Phone: 336-716-1331
  • Fax: 704-633-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004989
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004989
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: