Healthcare Provider Details

I. General information

NPI: 1104574920
Provider Name (Legal Business Name): ALYSSA RENEE ABERNATHY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 CROUSE LN
BURLINGTON NC
27215-8833
US

IV. Provider business mailing address

815 BLUE LAKE DR
MEBANE NC
27302-8694
US

V. Phone/Fax

Practice location:
  • Phone: 336-586-0994
  • Fax:
Mailing address:
  • Phone: 434-548-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number303024
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: