Provider Demographics
NPI:1093583429
Name:FEDDER, KATHRYN (PNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FEDDER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5476 CRESCENTVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4519
Mailing Address - Country:US
Mailing Address - Phone:910-528-9002
Mailing Address - Fax:
Practice Address - Street 1:135 TURNER ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7054
Practice Address - Country:US
Practice Address - Phone:910-246-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202326176363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics