Provider Demographics
NPI:1811944036
Name:LOUCKS, KATHLEEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1236
Mailing Address - Country:US
Mailing Address - Phone:919-956-4519
Mailing Address - Fax:919-688-3288
Practice Address - Street 1:3727 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4718
Practice Address - Country:US
Practice Address - Phone:919-956-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC180878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ17711Medicare UPIN