Healthcare Provider Details

I. General information

NPI: 1740897768
Provider Name (Legal Business Name): KATELIN RAYE TALBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 NUTT ST APT 361
WILMINGTON NC
28401-4391
US

IV. Provider business mailing address

7019 FALMOUTH CT SW
OCEAN ISLE BEACH NC
28469-0598
US

V. Phone/Fax

Practice location:
  • Phone: 302-643-2123
  • Fax: 302-337-5951
Mailing address:
  • Phone: 410-742-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50011455
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: