Provider Demographics
NPI:1063977106
Name:MCMANAMA, KATHERINE D'JERNES (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D'JERNES
Last Name:MCMANAMA
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WINDSOR CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-1208
Mailing Address - Country:US
Mailing Address - Phone:919-632-1740
Mailing Address - Fax:
Practice Address - Street 1:1238 HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-538-8093
Practice Address - Fax:336-538-7719
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011422363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner