Provider Demographics
NPI:1740891423
Name:STOODT, KATHRYN EMILY (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EMILY
Last Name:STOODT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:EMILY
Other - Last Name:FORTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15611 DEHAVILLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7257
Mailing Address - Country:US
Mailing Address - Phone:546-292-3189
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:2544 COURT DR STE F
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-864-8302
Practice Address - Fax:704-864-0228
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily