Healthcare Provider Details

I. General information

NPI: 1497328140
Provider Name (Legal Business Name): MICHAEL T FUTRELL AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 187
FAISON NC
28341-0187
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-267-0421
  • Fax: 910-378-1746
Mailing address:
  • Phone: 910-267-0421
  • Fax: 910-378-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5016060
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG07210139
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: