Healthcare Provider Details

I. General information

NPI: 1366517872
Provider Name (Legal Business Name): TERESA B HOPKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHURCH ST
LAKE WACCAMAW NC
28450-1909
US

IV. Provider business mailing address

107 CHURCH ST
LAKE WACCAMAW NC
28450-1909
US

V. Phone/Fax

Practice location:
  • Phone: 910-646-2107
  • Fax: 910-646-2252
Mailing address:
  • Phone: 910-646-2107
  • Fax: 910-646-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201040
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: