Healthcare Provider Details

I. General information

NPI: 1063106557
Provider Name (Legal Business Name): RICHARD KIRK FARMER HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 CREEDMOOR RD STE 114
RALEIGH NC
27613-3698
US

IV. Provider business mailing address

6863 COOPERS HAWK TRL
WENDELL NC
27591-6726
US

V. Phone/Fax

Practice location:
  • Phone: 919-812-2283
  • Fax:
Mailing address:
  • Phone: 919-181-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: