Healthcare Provider Details

I. General information

NPI: 1821135773
Provider Name (Legal Business Name): ISLAND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 US HIGHWAY 64
MANTEO NC
27954-9241
US

IV. Provider business mailing address

PO BOX 2360
MANTEO NC
27954-2360
US

V. Phone/Fax

Practice location:
  • Phone: 252-473-2500
  • Fax: 252-473-1222
Mailing address:
  • Phone: 252-473-2500
  • Fax: 252-473-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9401185
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number168637
License Number StateNC

VIII. Authorized Official

Name: JANET COOKE JARRETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 252-255-6005