Healthcare Provider Details

I. General information

NPI: 1225366453
Provider Name (Legal Business Name): ALLISON M. PRIEST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9858 N. W.R. LATHAN STREET
CLARKTON NC
28433-0095
US

IV. Provider business mailing address

2002 N CEDAR ST STE B
LUMBERTON NC
28358-3926
US

V. Phone/Fax

Practice location:
  • Phone: 910-647-1503
  • Fax: 910-647-1505
Mailing address:
  • Phone: 910-272-3048
  • Fax: 910-738-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004578
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: