Provider Demographics
NPI:1649206756
Name:DEWALD, KATHARINA (PMHNP)
Entity Type:Individual
Prefix:
First Name:KATHARINA
Middle Name:
Last Name:DEWALD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7669 ROCK RIDGE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-9361
Mailing Address - Country:US
Mailing Address - Phone:252-235-3320
Mailing Address - Fax:919-989-5278
Practice Address - Street 1:521 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-6400
Practice Address - Fax:919-989-5596
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200691363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily