Healthcare Provider Details

I. General information

NPI: 1255786273
Provider Name (Legal Business Name): NATHAN DE MCGEATHY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 RIVERSIDE DR
MOUNT AIRY NC
27030-3117
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-7892
  • Fax: 336-719-7898
Mailing address:
  • Phone: 336-719-7892
  • Fax: 336-719-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008606
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008606
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: