Healthcare Provider Details

I. General information

NPI: 1386571925
Provider Name (Legal Business Name): AHLEA LYNN SMALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 5TH ST
GREENVILLE NC
27858-2502
US

IV. Provider business mailing address

559 DEER RUN RD
NEW BERN NC
28562-9089
US

V. Phone/Fax

Practice location:
  • Phone: 252-328-6131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number284993
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: