Provider Demographics
NPI:1023010105
Name:GILBERT, KATIE O (FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:O
Last Name:GILBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6662
Mailing Address - Country:US
Mailing Address - Phone:910-791-9625
Mailing Address - Fax:910-792-9799
Practice Address - Street 1:1911 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6662
Practice Address - Country:US
Practice Address - Phone:910-791-9625
Practice Address - Fax:910-792-9799
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC039248207Q00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine