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1538774922

NPI Code Detail

MEDICARE: KATHRYN ROSE KEURIAN ARNP

MEDICARE: KATHRYN ROSE KEURIAN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	5013538	NC
2	363L00000X	Nurse Practitioner	RN264719	NC
3	363LG0600X	Gerontology Nurse Practitioner	5013538	NC
4	363LA2100X	Acute Care Nurse Practitioner	AP61251815	WA
5	363L00000X	Nurse Practitioner	AP61251815	WA
6	363L00000X	Nurse Practitioner	RN61245549	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538774922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ROSE KEURIAN ARNP

Provider Business Mailing Address
First Line	:	PO BOX 25608
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84125-0608
Country	:	US
Telephone Number	:	206-320-4476
Fax Number	:	206-568-7043

Provider Business Practice Location Address
First Line	:	4420 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-784-7110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	01/24/2026

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Directions to “ KATHRYN ROSE KEURIAN ARNP” Practice Location

Language	Start Address	Practice Location

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