Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 5009467 | NC |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9353737 | FL |
NPI | 1033456991 |
---|---|
Provider Name | Mrs. Katie Michelle Anthony |
First Address | Goldsboro, NC 27534-9460 |
Second Address | Goldsboro, NC 27534-9460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2013 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008218800 | (05) | FL |