1760776629 NPI number — KATELYN ELIZABETH EARLS M.D.

Table of content: KATELYN ELIZABETH EARLS M.D. (NPI 1760776629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760776629 NPI number — KATELYN ELIZABETH EARLS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EARLS
Provider First Name:
KATELYN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOLFREY
Provider Other First Name:
KATELYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760776629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 SUNFLOWER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHISPERING PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28327-7157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-642-8176
Provider Business Mailing Address Fax Number:
910-907-8614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 ROCK MERRITT AVE 5 SOUTH DOS- OPHTHALMOLOGY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-9238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-6423
Provider Business Practice Location Address Fax Number:
910-907-8614
Provider Enumeration Date:
06/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  D79289 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 0101252330 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)