Provider Demographics
NPI:1043282270
Name:PRATT, KATHERINE W (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:W
Last Name:PRATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:BRODY OUTPATIENT CENTER
Practice Address - Street 2:600 MOYE BLVD
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:28275-1069
Practice Address - Country:US
Practice Address - Phone:252-744-2350
Practice Address - Fax:252-744-3098
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200027363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000212Medicaid
NC2597504Medicare ID - Type Unspecified
NC7000212Medicaid