Provider Demographics
NPI:1942499231
Name:FERRELL, KATHLEEN ANN (PA-C, MPAS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:FERRELL
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:4142 BIOINFORMATICS BLDG
Practice Address - Street 2:CAMPUS BOX 7080
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7080
Practice Address - Country:US
Practice Address - Phone:919-966-2513
Practice Address - Fax:919-843-2508
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NC0010-02113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942499231Medicaid