MEDICARE: MICHAEL R ROYALL JR. NP

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	363L00000X	Nurse Practitioner	5011192	NC

General Provider Information

NPI Number	:	1356819320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R ROYALL JR. NP

Provider Business Mailing Address
First Line	:	507 N LINDSAY ST
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-4303
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:	336-899-2176

Provider Business Practice Location Address
First Line	:	190 INDEPENDENCE AVE STE B
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-4270
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:

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

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	02/07/2020

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