Provider Demographics
NPI:1245532423
Name:CHAVIS, KATARA S (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATARA
Middle Name:S
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8768
Mailing Address - Country:US
Mailing Address - Phone:910-521-0099
Mailing Address - Fax:910-521-0088
Practice Address - Street 1:205 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8768
Practice Address - Country:US
Practice Address - Phone:910-521-0099
Practice Address - Fax:910-521-0088
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005148363LF0000X, 363LF0000X
NCF0211283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily