Provider Demographics
NPI:1679929129
Name:BRICKER, KATELYN ROSE (MD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ROSE
Last Name:BRICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:170 MANNING DR
Mailing Address - Street 2:PHYSICIANS OFFICE BUILDING
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4221
Mailing Address - Country:US
Mailing Address - Phone:919-966-8162
Mailing Address - Fax:919-966-2922
Practice Address - Street 1:170 MANNING DR
Practice Address - Street 2:PHYSICIANS OFFICE BUILDING
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4221
Practice Address - Country:US
Practice Address - Phone:919-966-8162
Practice Address - Fax:919-966-2922
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2188512084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology