Healthcare Provider Details

I. General information

NPI: 1841927001
Provider Name (Legal Business Name): SARAH LYNN MEVISSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH LYNN CARBAJAL FNP

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 JOHN KNOX DR
COLFAX NC
27235-9662
US

IV. Provider business mailing address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106-3410
US

V. Phone/Fax

Practice location:
  • Phone: 336-325-0130
  • Fax:
Mailing address:
  • Phone: 336-325-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016621
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: