Healthcare Provider Details

I. General information

NPI: 1508166885
Provider Name (Legal Business Name): KATHERINE WINESETT DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 NC HIGHWAY 45 N
PLYMOUTH NC
27962-9232
US

IV. Provider business mailing address

198 NC HIGHWAY 45 N
PLYMOUTH NC
27962-9232
US

V. Phone/Fax

Practice location:
  • Phone: 252-791-3152
  • Fax: 252-791-3158
Mailing address:
  • Phone: 252-791-3152
  • Fax: 252-791-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: