Healthcare Provider Details

I. General information

NPI: 1699943241
Provider Name (Legal Business Name): DEBRA D MOFFITT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W WALKER AVE
ASHEBORO NC
27203-6760
US

IV. Provider business mailing address

PO BOX 9
WEST END NC
27376-0009
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-7000
  • Fax: 336-625-4969
Mailing address:
  • Phone: 910-673-9111
  • Fax: 910-673-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number100674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: