Provider Demographics
NPI:1447679493
Name:BUMGARNER, KATHERINE NICOLE (MSN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WALNUT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6772
Mailing Address - Country:US
Mailing Address - Phone:919-270-3669
Mailing Address - Fax:
Practice Address - Street 1:4908 S HILL VIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-2338
Practice Address - Country:US
Practice Address - Phone:919-270-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180325367500000X
NC217578367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered