Provider Demographics
NPI:1578021309
Name:KIM, CATHERINE HONG (NP-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:HONG
Last Name:KIM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MEDICAL PAVILION DRIVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8957
Mailing Address - Country:US
Mailing Address - Phone:910-904-8071
Mailing Address - Fax:
Practice Address - Street 1:210 MEDICAL PAVILION DRIVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8957
Practice Address - Country:US
Practice Address - Phone:910-904-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014311363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02210020OtherAANP
NC5014311OtherNCBON