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General NPI Number Information
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NPI Number | 1023534864
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Entity Type | Individual
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Provider Name | KATHRYN NICOLE PREAST FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1325 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-1435
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Country | US
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Telephone | 814-494-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 151 VIOLETEAR RDG
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8855
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN89601FNPBC
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License Number State | WV
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