Healthcare Provider Details

I. General information

NPI: 1538126677
Provider Name (Legal Business Name): ANGELA DENISE POIRSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ANGELA DENISE PARKER

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

5232 HEATHER ST
HOPE MILLS NC
28348-7836
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax: 910-482-5174
Mailing address:
  • Phone: 910-364-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR863688
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: