Individual
KATIE WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
50 W 4TH ST APT 10, SUITE 10, WINSTON SALEM, NC 27101-4089
(336) 718-4700
(336) 718-4702
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 718-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NC
363AM0700X
Medical Physician Assistant
0010-03309
NC
363AM0700X
Medical Physician Assistant
MA054158
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232009
MEDICARE PTAN, GROUP CMCNE
NC
01
—
NC4836A
MEDICARE PTAN, INDIVIDUAL
NC
Enumeration date
10/08/2009
Last updated
08/22/2016
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