Provider Demographics
NPI:1477780377
Name:PASCHALL, KATRINA GREEN (MED)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:GREEN
Last Name:PASCHALL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-8110
Mailing Address - Country:US
Mailing Address - Phone:866-611-2144
Mailing Address - Fax:866-209-1103
Practice Address - Street 1:2084 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8110
Practice Address - Country:US
Practice Address - Phone:866-611-2144
Practice Address - Fax:866-209-1103
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477780377Medicaid