Healthcare Provider Details

I. General information

NPI: 1841823572
Provider Name (Legal Business Name): FRANCESCA SHROUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FALCON CREST LN
CLYDE NC
28721-6620
US

IV. Provider business mailing address

11 FALCON CREST LN
CLYDE NC
28721-6620
US

V. Phone/Fax

Practice location:
  • Phone: 828-565-0560
  • Fax: 828-565-0562
Mailing address:
  • Phone: 828-565-0560
  • Fax: 828-565-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: