Healthcare Provider Details

I. General information

NPI: 1174732978
Provider Name (Legal Business Name): JOANN CAROLYN SUMNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 PERIMETER PKWY STE 200
CHARLOTTE NC
28216-2447
US

IV. Provider business mailing address

PO BOX 2034
SYLVA NC
28779-2034
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-7379
  • Fax: 855-857-7333
Mailing address:
  • Phone: 828-586-8160
  • Fax: 828-586-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number056393
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: