Healthcare Provider Details

I. General information

NPI: 1467435040
Provider Name (Legal Business Name): WNC INTERNAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 COPE CREEK RD STE A-B
SYLVA NC
28779-9508
US

IV. Provider business mailing address

98 COPE CREEK RD STE A-B
SYLVA NC
28779-9508
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-7798
  • Fax: 866-282-0679
Mailing address:
  • Phone: 828-586-7798
  • Fax: 866-282-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20370
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00220
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200500976
License Number StateNC

VIII. Authorized Official

Name: MELISSA QUEEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-586-7796