Healthcare Provider Details

I. General information

NPI: 1164374203
Provider Name (Legal Business Name): KATELYN NICOLE COFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5345
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-9300
  • Fax: 910-754-3261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number700701
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number33145
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: