Active NPI
Kathryn Anne Hetrick, D.D.S.
- Dentist
- Knightdale, NC
National Provider Identifier
1033510813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 057496-1
- Practice address
- 1008 Big Oak CT Ste C
Knightdale, NC 27545-6566 - Phone
- (919) 266-3380
- NPI assigned
- Sep 11, 2014
- Last updated
- Aug 26, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 057496-1 | NY | Primary |
Addresses
Primary practice location
1008 Big Oak CT Ste C
Knightdale, NC 27545-6566
Mailing address
10 Crawford CT
Durham, NC 27703-9475
Phone (913) 593-6990
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057496-1 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1033510813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CRAWFORD CT",
"city": "DURHAM",
"state": "NC",
"postal_code": "277039475",
"telephone_number": "913-593-6990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1008 BIG OAK CT STE C",
"city": "KNIGHTDALE",
"state": "NC",
"postal_code": "275456566",
"telephone_number": "919-266-3380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETRICK",
"first_name": "KATHRYN",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-11",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "057496-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knightdale, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.