Healthcare Provider Details

I. General information

NPI: 1194389353
Provider Name (Legal Business Name): KATHERINE SERAFEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 CREEDMOOR RD STE 105
RALEIGH NC
27613-1695
US

IV. Provider business mailing address

7209 CREEDMOOR RD STE 105
RALEIGH NC
27613-1695
US

V. Phone/Fax

Practice location:
  • Phone: 919-307-9461
  • Fax: 919-714-0909
Mailing address:
  • Phone: 919-307-9461
  • Fax: 919-714-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9798
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13643
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: