Provider Demographics
NPI:1790774644
Name:RHOADES, KAY (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:
Last Name:RHOADES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-1227
Mailing Address - Country:US
Mailing Address - Phone:910-582-4003
Mailing Address - Fax:910-582-8212
Practice Address - Street 1:104 RICE ST
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-3304
Practice Address - Country:US
Practice Address - Phone:910-582-4003
Practice Address - Fax:910-582-8212
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000303Medicaid
NC7000303Medicaid
NC2310716Medicare ID - Type Unspecified
NC2805210AMedicare ID - Type UnspecifiedEFFECTIVE DATE OF 1-1-06