Provider Demographics
NPI:1841281888
Name:FOULK, KATHLEEN T
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:T
Last Name:FOULK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 JABARA AVE
Mailing Address - Street 2:SEYMOUR JOHNSON AFB
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27531-2310
Mailing Address - Country:US
Mailing Address - Phone:919-722-0928
Mailing Address - Fax:919-722-1952
Practice Address - Street 1:1050 JABARA AVE
Practice Address - Street 2:SEYMOUR JOHNSON AFB
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27531-2310
Practice Address - Country:US
Practice Address - Phone:919-722-0928
Practice Address - Fax:919-722-1952
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health