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General NPI Number Information
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NPI Number | 1336894609
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE GLASS DNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 2001 S MAIN ST
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City | WAKE FOREST
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State | NC
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Zip | 27587-1649
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Country | US
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Telephone | 919-350-0365
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 MOUNT VERNON CHURCH RD
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City | RALEIGH
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State | NC
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Zip | 27614-7154
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Country | US
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Telephone | 717-494-9165
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5015783
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License Number State | NC
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