Healthcare Provider Details

I. General information

NPI: 1760133581
Provider Name (Legal Business Name): SHALINA STILES LITTLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 3RD ST
AURORA NC
27806-9088
US

IV. Provider business mailing address

235 HOLLIS RD
PLYMOUTH NC
27962-9116
US

V. Phone/Fax

Practice location:
  • Phone: 252-322-4021
  • Fax:
Mailing address:
  • Phone: 252-531-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: