Healthcare Provider Details

I. General information

NPI: 1760577977
Provider Name (Legal Business Name): MARY KATHERINE TAYLOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 S 16TH ST SUITE A
WILMINGTON NC
28401-6472
US

IV. Provider business mailing address

PO BOX 15109
WILMINGTON NC
28408-5109
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-8633
  • Fax: 910-452-8569
Mailing address:
  • Phone: 910-392-2525
  • Fax: 910-392-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5005154
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: