Provider Demographics
NPI:1235536210
Name:LOFLAND, KATHRYN ALICE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALICE
Last Name:LOFLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-9252
Mailing Address - Fax:336-716-0030
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-2927
Practice Address - Country:US
Practice Address - Phone:336-713-5215
Practice Address - Fax:336-716-0030
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC203266363L00000X
NC5007339363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3055Medicaid
NC1235536210Medicaid
SCNP3055Medicaid
NC1235536210Medicaid
NCNCM061DMedicare PIN
NCNCM061BMedicare PIN