Healthcare Provider Details

I. General information

NPI: 1679395800
Provider Name (Legal Business Name): BETH COLLEEN TRUCKSA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OUTCOMES MANAGEMENT 2817 ROCK MERRITT AVENUE
FORT LIBERTY NC
28310
US

IV. Provider business mailing address

2817 ROCK MERRITT AVENUE
FORT LIBERTY NC
28310
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-9178
  • Fax:
Mailing address:
  • Phone: 910-907-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number198125
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: