Provider Demographics
NPI:1366680373
Name:PEPPERS, KATHERINE H (DNP, CPNP, CPMHS,)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:H
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:DNP, CPNP, CPMHS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 DEERGRASS CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6568
Mailing Address - Country:US
Mailing Address - Phone:919-862-7633
Mailing Address - Fax:949-437-2099
Practice Address - Street 1:2473 WENDELL BLVD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-6903
Practice Address - Country:US
Practice Address - Phone:919-622-0255
Practice Address - Fax:949-437-2099
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC215733363L00000X, 363LP0808X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004663Medicaid
NC5004284OtherNC STATE LICENSE