Provider Demographics
NPI:1750397717
Name:SHEA, KATHERINE BOYD (PA)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BOYD
Last Name:SHEA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 S STERLING ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4092
Mailing Address - Country:US
Mailing Address - Phone:828-580-4661
Mailing Address - Fax:828-580-4698
Practice Address - Street 1:2209 S STERLING ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4092
Practice Address - Country:US
Practice Address - Phone:828-580-4661
Practice Address - Fax:828-580-4698
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101984Medicaid
NC1750397717Medicaid
NC8101984Medicaid
NC2748157AMedicare ID - Type Unspecified