Healthcare Provider Details

I. General information

NPI: 1275011017
Provider Name (Legal Business Name): RACHAEL PITTS FARISH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 ENON RD
VALDESE NC
28690-9314
US

IV. Provider business mailing address

902 KIRKWOOD AVE NW
LENOIR NC
28645-5121
US

V. Phone/Fax

Practice location:
  • Phone: 828-879-1601
  • Fax: 828-874-1403
Mailing address:
  • Phone: 828-754-0101
  • Fax: 828-757-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010719
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010719
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: