=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972462869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CATHERINE MARIE HEADLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2026
-----------------------------------------------------
Last Update Date | 01/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 US 421 S
-----------------------------------------------------
City | LILLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27546-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-893-1210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 GRIGSBY AVE
-----------------------------------------------------
City | HOLLY SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27540-8947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------