Provider Demographics
NPI:1720379514
Name:DUNLAP, KATHLEEN BEACH JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:BEACH JACKSON
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-398-3601
Mailing Address - Fax:828-333-5465
Practice Address - Street 1:125 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-398-3601
Practice Address - Fax:828-333-5465
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-021902084P0804X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720379514Medicaid
NCNCU353COtherPTAN (PSYCHIATRY OB)
NCNCU353BOtherPTAN (PSYCHIATRY)