Provider Demographics
NPI:1467823179
Name:MCKITHAN, STEPHANIE BOURNE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BOURNE
Last Name:MCKITHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 PARKWAY DR STE C
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9432
Mailing Address - Country:US
Mailing Address - Phone:919-751-8444
Mailing Address - Fax:
Practice Address - Street 1:1208 PARKWAY DR STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9432
Practice Address - Country:US
Practice Address - Phone:919-751-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC188971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily