Healthcare Provider Details

I. General information

NPI: 1639276280
Provider Name (Legal Business Name): JULIA COOKE PLEMMONS MN,WHNP,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 PARAGON PARKWAY
CLYDE NC
28721-9463
US

IV. Provider business mailing address

157 PARAGON PARKWAY
CLYDE NC
28721-9463
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-6675
  • Fax: 828-452-6730
Mailing address:
  • Phone: 828-452-6675
  • Fax: 828-452-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number057203
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number940054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: