Healthcare Provider Details

I. General information

NPI: 1285291377
Provider Name (Legal Business Name): LAURA KATHRYN TRYON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S ALLEN RD
FLAT ROCK NC
28731-9447
US

IV. Provider business mailing address

571 S ALLEN RD
FLAT ROCK NC
28731-9447
US

V. Phone/Fax

Practice location:
  • Phone: 828-692-6178
  • Fax: 828-692-2365
Mailing address:
  • Phone: 828-692-6178
  • Fax: 828-692-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011723
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011723
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5011723
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNP LICENSE
# 2
Identifier239400
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerRN LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: