Provider Demographics
NPI:1780008037
Name:WINGATE, KATIE SCOTT (NP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SCOTT
Last Name:WINGATE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:420 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2534
Mailing Address - Country:US
Mailing Address - Phone:336-993-1618
Mailing Address - Fax:336-993-5512
Practice Address - Street 1:420 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2534
Practice Address - Country:US
Practice Address - Phone:336-993-1618
Practice Address - Fax:336-993-5512
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006717363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5006717OtherNURSE PRACTITIONER APPROVAL NUMBER