Provider Demographics
NPI:1285876714
Name:LITTLE, KATINA DENA' (CPNP)
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:DENA'
Last Name:LITTLE
Suffix:
Gender:F
Credentials:CPNP
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Other - Credentials:
Mailing Address - Street 1:376 HOLLINSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6245
Mailing Address - Country:US
Mailing Address - Phone:336-608-7411
Mailing Address - Fax:
Practice Address - Street 1:2509A LEWISVILLE CLEMMONS RD # 1004
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8712
Practice Address - Country:US
Practice Address - Phone:336-608-7411
Practice Address - Fax:336-920-3731
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20090378363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20090378OtherPEDIATRIC NURSING CERTIFICATION BOARD