Healthcare Provider Details

I. General information

NPI: 1073268413
Provider Name (Legal Business Name): MRS. EMILY RIDGELY MCCREA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 THE CIRCLE AT NORTH HILLS ST
RALEIGH NC
27609-5712
US

IV. Provider business mailing address

4191 THE CIRCLE AT NORTH HILLS ST
RALEIGH NC
27609-5712
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-1075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5018956
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: