Individual
KATHERINE LAURA TISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1017 ASHES DR STE 206, WILMINGTON, NC 28405-8308
(910) 239-9584
(910) 679-4086
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
2021-01418
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740676022
—
NC
01
—
NNG327A
MEDICARE PTAN
NC
Enumeration date
04/13/2015
Last updated
10/30/2023
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