Healthcare Provider Details

I. General information

NPI: 1851984082
Provider Name (Legal Business Name): JODIE BUTLER HALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 NC HWY 50
MAPLE HILL NC
28454-8153
US

IV. Provider business mailing address

8905 NEW FOREST DR
WILMINGTON NC
28411-8939
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-6444
  • Fax: 910-259-6659
Mailing address:
  • Phone: 336-596-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014107
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: