Healthcare Provider Details

I. General information

NPI: 1346219367
Provider Name (Legal Business Name): JOHN VICTOR KORBY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLGG 5-4257 BASTOGNE STREET EXT.
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

514 ASHLEY CT
CHAPEL HILL NC
27514-1804
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-9557
  • Fax:
Mailing address:
  • Phone: 919-933-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number098399
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: