Provider Demographics
NPI:1417927864
Name:MYERS, KATHERINE MCCOY (PA C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MCCOY
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8833 WALKING STICK TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4037
Mailing Address - Country:US
Mailing Address - Phone:919-918-4471
Mailing Address - Fax:
Practice Address - Street 1:10880 DURANT RD
Practice Address - Street 2:SUITE 124
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6628
Practice Address - Country:US
Practice Address - Phone:919-800-2442
Practice Address - Fax:919-800-2440
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant