MEDICARE: AESTHETIC COUTURE, PLLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1538867312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETIC COUTURE, PLLC

Provider Business Mailing Address
First Line	:	809 GREEN VALLEY RD STE 114
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7055
Country	:	US
Telephone Number	:	615-708-1450
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 GREEN VALLEY RD STE 114
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7055
Country	:	US
Telephone Number	:	376-933-6708
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JACKLYN MARIE HALPIN
Credential	:	DNP
Telephone Number	:	615-708-1450

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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