Healthcare Provider Details

I. General information

NPI: 1619783651
Provider Name (Legal Business Name): MICHAELA ELIZABETH FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SPRINGWOOD DR NE
VALDESE NC
28690-8710
US

IV. Provider business mailing address

206 PATTERSON ST STE C
MORGANTON NC
28655-3351
US

V. Phone/Fax

Practice location:
  • Phone: 828-879-8419
  • Fax:
Mailing address:
  • Phone: 315-224-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: