Healthcare Provider Details

I. General information

NPI: 1598545816
Provider Name (Legal Business Name): KATHERINE HUEY NICHOLAS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N 3RD ST STE 401
WILMINGTON NC
28401-3474
US

IV. Provider business mailing address

720 N 3RD ST STE 401
WILMINGTON NC
28401-3474
US

V. Phone/Fax

Practice location:
  • Phone: 910-769-9126
  • Fax: 910-769-9169
Mailing address:
  • Phone: 910-769-9126
  • Fax: 910-769-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018939
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5018939
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberHUEY-G1RP3
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: