Katie Domorski, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5014999 Issued in NC

Practice address

106 Hyannis Dr
Holly Springs, NC 27540-8327

Phone

(919) 249-4700

NPI assigned

Sep 6, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Holly Springs Pediatrics

  • Pediatrics Physician
  • Holly Springs, NC
  • NPI 1558514752
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630886400000",
    "number": "1326716119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 BRAEBURN DR",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275398001",
            "telephone_number": "252-723-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 HYANNIS DR",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275408327",
            "telephone_number": "919-249-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMORSKI",
        "first_name": "KATIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-06",
        "last_updated": "2021-09-06",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5014999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Katherine Dicks, LCMHC-A
• Diverse Healthcare Consultants, PLLC
• Jacqueline Dix
• Matthew Doell
• Tami S Doherty
• Donna R B Rogers PLLC
• Dr Dasari DMD PLLC
• Dr. Anita Bhat, PLLC
• Dr. Phillip M. Vito
• Dressen Medical Supply, Inc

• Pediatric Nurse Practitioner in Holly Springs, NC
• Providers in Holly Springs, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.