Healthcare Provider Details

I. General information

NPI: 1669111449
Provider Name (Legal Business Name): RACHEL LAIRD THOMASSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 REGIONAL CIR STE B
PINEHURST NC
28374-9845
US

IV. Provider business mailing address

331 JANNIE LN
CARTHAGE NC
28327-7143
US

V. Phone/Fax

Practice location:
  • Phone: 910-215-0111
  • Fax:
Mailing address:
  • Phone: 910-354-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016259
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: