Healthcare Provider Details

I. General information

NPI: 1083575385
Provider Name (Legal Business Name): KATELYN IRELAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 COMPUTER DR STE 300
RALEIGH NC
27609-6518
US

IV. Provider business mailing address

3809 COMPUTER DR STE 300
RALEIGH NC
27609-6518
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-9078
  • Fax: 919-719-0147
Mailing address:
  • Phone: 919-781-9078
  • Fax: 919-719-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: