Healthcare Provider Details

I. General information

NPI: 1356845309
Provider Name (Legal Business Name): UNIVERSITY OF NORTH CAROLINA AT PEMBROKE STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HAWK DRIVE
PEMBROKE NC
28372-1510
US

IV. Provider business mailing address

PO BOX 1510 UNC PEMBROKE STUDENT HEALTH SERVICES
PEMBROKE NC
28372-1510
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-6219
  • Fax: 910-521-6549
Mailing address:
  • Phone: 910-521-6219
  • Fax: 910-521-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number183091
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number183091
License Number StateNC

VIII. Authorized Official

Name: DR. JEFFERY L. HOWARD
Title or Position: VICE CHANCELLOR FOR STUDENT AFFAIRS
Credential: ED.D
Phone: 910-521-6175