Healthcare Provider Details

I. General information

NPI: 1508674045
Provider Name (Legal Business Name): SUMMER GALE CAHOON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 01/14/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 PRISON RD.
SWANQUARTER NC
27885
US

IV. Provider business mailing address

5201 MAIL SERVICE CTR
RALEIGH NC
27699-5201
US

V. Phone/Fax

Practice location:
  • Phone: 252-926-1810
  • Fax:
Mailing address:
  • Phone: 252-926-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332802
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: