Basic Information
| Provider Information | |||||||||
| NPI: | 1669952248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUPIK | ||||||||
| FirstName: | KATHIE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 ALTHEA RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287799055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283420687 | ||||||||
| FaxNumber: | 8283390173 | ||||||||
| Practice Location | |||||||||
| Address1: | 63 HEALTHCARE DR | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287795120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285867798 | ||||||||
| FaxNumber: | 8283390173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5010585 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.