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General NPI Number Information
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NPI Number | 1669506481
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Entity Type | Individual
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Provider Name | KERSTIN M. C. NYGARD PA-C, MHS
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10 SUNNYBROOK RD CLINIC G, WCHS
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City | RALEIGH
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State | NC
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Zip | 27610-1808
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Country | US
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Telephone | 919-212-7991
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Fax | 919-250-4517
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Provider Business Mailing Address
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Address Line | 5708 COLE MILL RD
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City | DURHAM
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State | NC
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Zip | 27705-8272
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Country | US
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Telephone | 919-383-7886
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101186
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License Number State | NC
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