Provider Demographics
NPI:1275796534
Name:CHURCH, KATHERINE A (RN MSN CPNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:CHURCH
Suffix:
Gender:F
Credentials:RN MSN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 25TH AVE. DR. NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9655
Mailing Address - Country:US
Mailing Address - Phone:828-324-4453
Mailing Address - Fax:828-324-9295
Practice Address - Street 1:1455 25TH AVENUE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9677
Practice Address - Country:US
Practice Address - Phone:828-324-4453
Practice Address - Fax:828-324-9295
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168048363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics