MEDICARE: DEERNIS CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1104629955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEERNIS CARE LLC

Provider Business Mailing Address
First Line	:	87 FROGTOWN LN
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28734-2094
Country	:	US
Telephone Number	:	828-333-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 FROGTOWN LN
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28734-2094
Country	:	US
Telephone Number	:	828-333-4525
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HENRY BRAHAM EDWARDS
Credential	:
Telephone Number	:	828-333-4525

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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Directions to “DEERNIS CARE LLC ” Practice Location

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