Healthcare Provider Details

I. General information

NPI: 1235294588
Provider Name (Legal Business Name): JEANETTE MOORE FURAN L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 SILVERS WELCH RD
OLD FORT NC
28762-8755
US

IV. Provider business mailing address

852 SILVERS WELCH RD
OLD FORT NC
28762-8755
US

V. Phone/Fax

Practice location:
  • Phone: 828-668-4018
  • Fax: 828-668-4018
Mailing address:
  • Phone: 828-668-4018
  • Fax: 828-668-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3479
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6103056
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: