Provider Demographics
NPI:1063458941
Name:GAINES, CATHERINE LYN (PA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LYN
Last Name:GAINES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2600 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-671-5195
Mailing Address - Fax:910-671-5538
Practice Address - Street 1:1200 PINE RUN DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2180
Practice Address - Country:US
Practice Address - Phone:910-671-5730
Practice Address - Fax:910-671-5538
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010625-1363AS0400X
NC0010-00752363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2769781Medicare PIN