Provider Demographics
NPI:1558027748
Name:STUTESMAN, KATHLEEN BARKLEY (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BARKLEY
Last Name:STUTESMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MICHELLE
Other - Last Name:BARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6324 FAIRVIEW RD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4278
Practice Address - Country:US
Practice Address - Phone:704-384-0588
Practice Address - Fax:704-384-0580
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBARK-WGX38363LF0000X
NC5015423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily