Provider Demographics
NPI:1861484107
Name:MOUSER, KATHERINE D (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:D
Last Name:MOUSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 METROMEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-568-3903
Mailing Address - Fax:910-568-3908
Practice Address - Street 1:1774 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-568-3903
Practice Address - Fax:910-568-3908
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0001-04204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762971Medicare ID - Type UnspecifiedPROVIDER NUMBER
NCQ36659Medicare UPIN