Provider Demographics
NPI:1154666402
Name:LOVE, KAY A (NP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:A
Last Name:LOVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-543-6636
Mailing Address - Fax:704-541-9476
Practice Address - Street 1:7810 PROVIDENCE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2954
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:704-541-9476
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006511Medicaid
NCNCA685CMedicare PIN
NCNCA685AMedicare PIN
NCNCA685GMedicare PIN
NCNCA685FMedicare PIN
NC7006511Medicaid
NCNCA685BMedicare PIN
NCNCA685DMedicare PIN
NCNCA685EMedicare PIN