Provider Demographics
NPI:1154891646
Name:MEDELLIN, CATHLEEN
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:MEDELLIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 JOHNSTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5345
Mailing Address - Country:US
Mailing Address - Phone:337-991-9276
Mailing Address - Fax:
Practice Address - Street 1:5306 NC HIGHWAY 55 STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7812
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.023787363LF0000X
NC5014339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily