Provider Demographics
NPI:1629702444
Name:EBERHARD, KATHERINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:EBERHARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 ROSEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1627
Mailing Address - Country:US
Mailing Address - Phone:607-321-5887
Mailing Address - Fax:
Practice Address - Street 1:6800 E GENESEE ST STE 1200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1097
Practice Address - Country:US
Practice Address - Phone:315-251-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY770786163W00000X
NY350060363LF0000X
NC345907163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse