Provider Demographics
NPI:1316207905
Name:LILLETHUN, MARTHA KATE MCKEMIE (FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:KATE MCKEMIE
Last Name:LILLETHUN
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 1:119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-771-5500
Mailing Address - Fax:828-771-5454
Practice Address - Street 1:119 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-771-5500
Practice Address - Fax:828-257-4750
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214924363L00000X
NC5005613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC9622BOtherPTAN