Healthcare Provider Details

I. General information

NPI: 1932457694
Provider Name (Legal Business Name): KATHLEEN SANDRA SISK PMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MILLSTONE DR SUITE A
HILLSBOROUGH NC
27278-8776
US

IV. Provider business mailing address

PO BOX 612
MEBANE NC
27302-0612
US

V. Phone/Fax

Practice location:
  • Phone: 919-245-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number151808
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number151808
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: