Provider Demographics
NPI:1649641093
Name:PEELE, KATLYN KEECH (AGNP)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:KEECH
Last Name:PEELE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CANTERBERRY RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-5405
Mailing Address - Country:US
Mailing Address - Phone:252-945-5066
Mailing Address - Fax:
Practice Address - Street 1:598 WEST COUNTY RD
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810
Practice Address - Country:US
Practice Address - Phone:252-943-0600
Practice Address - Fax:252-943-2377
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC264573363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner