Provider Demographics
NPI:1811179146
Name:CATHERINE MYTON,ARNP,PH.D
Entity type:Organization
Organization Name:CATHERINE MYTON,ARNP,PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYTON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:828-863-2554
Mailing Address - Street 1:PO BOX 1412
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-1412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 COMMERCIAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2400
Practice Address - Country:US
Practice Address - Phone:828-863-4554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC950016363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005017Medicaid
NCP51899Medicare UPIN
NC6005017Medicaid