Individual
MRS. KATHRYN SHEETS BOULINEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
101 HEART DR, GREENVILLE, NC 27834-8982
(252) 744-4611
(252) 744-3201
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00317
NC
363AS0400X
Surgical Physician Assistant
0010-00317
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189TE
BCBS OF NC
NC
05
—
1982661450
—
NC
Enumeration date
04/28/2006
Last updated
02/01/2024
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