Healthcare Provider Details

I. General information

NPI: 1508777939
Provider Name (Legal Business Name): THOMAS PATRICK MCMAHON JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 KENANSVILLE BYP
KENANSVILLE NC
28349-9064
US

IV. Provider business mailing address

748 KENANSVILLE BYP
KENANSVILLE NC
28349-9064
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-8080
  • Fax:
Mailing address:
  • Phone: 910-296-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number372540
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: