Healthcare Provider Details

I. General information

NPI: 1982254884
Provider Name (Legal Business Name): SARAH SUMMERTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 N CROATAN HWY
KITTY HAWK NC
27949-3988
US

IV. Provider business mailing address

5120 N CROATAN HWY
KITTY HAWK NC
27949-3988
US

V. Phone/Fax

Practice location:
  • Phone: 252-449-5780
  • Fax: 252-449-5799
Mailing address:
  • Phone: 252-449-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012266
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: