Healthcare Provider Details

I. General information

NPI: 1790774644
Provider Name (Legal Business Name): KAY RHOADES ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 RICE ST
HAMLET NC
28345-3304
US

IV. Provider business mailing address

PO BOX 1227
HAMLET NC
28345-1227
US

V. Phone/Fax

Practice location:
  • Phone: 910-582-4003
  • Fax: 910-582-8212
Mailing address:
  • Phone: 910-582-4003
  • Fax: 910-582-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: