MEDICARE: MRS. RAEGAN MCNEIL CHURCH FNP-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
1	363LF0000X	Family Nurse Practitioner	5013710	NC

General Provider Information

NPI Number	:	1194324756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAEGAN MCNEIL CHURCH FNP-C

Provider Business Mailing Address
First Line	:	310 HOSPITAL AVE
Second Line	:
City	:	JEFFERSON
State	:	NC
Zip	:	28640
Country	:	US
Telephone Number	:	336-846-6322
Fax Number	:

Provider Business Practice Location Address
First Line	:	8439 VALLEY BLVD
Second Line	:
City	:	BLOWING ROCK
State	:	NC
Zip	:	28605-8957
Country	:	US
Telephone Number	:	828-295-3116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	12/06/2023

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