Provider Demographics
NPI:1952561615
Name:CARNES, CATHERINE KELLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:KELLEY
Last Name:CARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 SIMONTON RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8246
Mailing Address - Country:US
Mailing Address - Phone:704-375-0100
Mailing Address - Fax:
Practice Address - Street 1:2347 SIMONTON RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8246
Practice Address - Country:US
Practice Address - Phone:704-375-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC149614251G00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915716Medicaid
NC5915716Medicaid