Provider Demographics
NPI:1174864656
Name:MANN, CATHY GAYLE (FNP-C)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:GAYLE
Last Name:MANN
Suffix:
Gender:F
Credentials:FNP-C
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 986513
Mailing Address - Street 2:DEPT 100
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8326
Mailing Address - Fax:910-939-4269
Practice Address - Street 1:338 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7928
Practice Address - Country:US
Practice Address - Phone:252-223-5054
Practice Address - Fax:252-223-4038
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20244363LF0000X
NC5006106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4065Medicaid