Healthcare Provider Details

I. General information

NPI: 1316274087
Provider Name (Legal Business Name): MIRANDA KENT FLOWERS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MIRANDA SHANE KENT

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN ROAD
DURHAM NC
27710-0000
US

IV. Provider business mailing address

2301 ERWIN ROAD DUMC BOX 3458
DURHAM NC
27710-0000
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-2425
  • Fax: 919-681-7163
Mailing address:
  • Phone: 919-681-2425
  • Fax: 919-681-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number207091
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: