Healthcare Provider Details

I. General information

NPI: 1215419825
Provider Name (Legal Business Name): CAROL JOSEPHINE GATES DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-413-6202
  • Fax:
Mailing address:
  • Phone: 252-413-6202
  • Fax: 252-752-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010928
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: