Provider Demographics
NPI:1619949922
Name:MASON, KATHERINE WRIGHT (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:WRIGHT
Last Name:MASON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:DEVOILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6448
Mailing Address - Fax:910-615-5070
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-5132
Practice Address - Fax:910-321-6236
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111386367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052398Medicaid
NC2610236Medicare ID - Type UnspecifiedPROVIDER NUMBER