Healthcare Provider Details

I. General information

NPI: 1376250183
Provider Name (Legal Business Name): ADMINISTRATION OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 S RAEFORD RD
FAYETTEVILLE NC
28304-6162
US

IV. Provider business mailing address

7300 S RAEFORD RD
FAYETTEVILLE NC
28304-6162
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax:
Mailing address:
  • Phone: 910-488-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBRA YOUNG
Title or Position: MANAGER
Credential:
Phone: 910-488-2120