Provider Demographics
NPI:1386299691
Name:KREIS, KATHRYN ANN (AGNP -C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:KREIS
Suffix:
Gender:F
Credentials:AGNP -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 COMPUTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6518
Mailing Address - Country:US
Mailing Address - Phone:197-819-0789
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8779
Practice Address - Fax:919-350-8812
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017774363LA2200X
NC204621163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health