Provider Demographics
NPI:1033456991
Name:ANTHONY, KATIE MICHELLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MICHELLE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:MICHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2706 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2706 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-734-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009467363LP0200X
FLARNP9353737363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008218800Medicaid
FL008218800Medicaid
FLHB182VMedicare PIN
FLHB182ZMedicare PIN
FLHB182XMedicare PIN
FLHB182WMedicare PIN