Healthcare Provider Details

I. General information

NPI: 1184106098
Provider Name (Legal Business Name): KATHRYN JEAN GILL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MORASH AGACNP-BC

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 FALLS OF NEUSE RD STE 420
RALEIGH NC
27609-6374
US

IV. Provider business mailing address

325 SILVER MAPLE DR
FUQUAY VARINA NC
27526-4544
US

V. Phone/Fax

Practice location:
  • Phone: 919-877-9959
  • Fax:
Mailing address:
  • Phone: 774-392-4125
  • Fax: 470-221-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5016516
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN276387
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: