Provider Demographics
NPI:1134587645
Name:HANCOCK, KATIE GOULD (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:GOULD
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W HARGETT ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1700
Mailing Address - Country:US
Mailing Address - Phone:919-550-0821
Mailing Address - Fax:919-882-9570
Practice Address - Street 1:935 SHOTWELL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5597
Practice Address - Country:US
Practice Address - Phone:919-550-0821
Practice Address - Fax:919-882-9570
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06210363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical