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NPI Code Detail

MEDICARE: MISTY LYNN ROUSE PA-C

MEDICARE: MISTY LYNN ROUSE PA-C
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
1363A00000XPhysician Assistant001001458NC

General Provider Information

NPI Number : 1184880130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY LYNN ROUSE PA-C
Provider Business Mailing Address
First Line : 201 N BREAZEALE AVE
Second Line :
City : MOUNT OLIVE
State : NC
Zip : 28365-1603
Country : US
Telephone Number : 919-658-4954
Fax Number : 919-658-5754
Provider Business Practice Location Address
First Line : 201 N BREAZEALE AVE
Second Line :
City : MOUNT OLIVE
State : NC
Zip : 28365-1603
Country : US
Telephone Number : 919-658-4954
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2008
Last Update Date : 03/27/2023

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Directions to “ MISTY LYNN ROUSE PA-C” Practice Location

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