Healthcare Provider Details

I. General information

NPI: 1063765345
Provider Name (Legal Business Name): STEPHANIE MILLS WYNN RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W 15TH ST
WASHINGTON NC
27889-3591
US

IV. Provider business mailing address

2005 W 15TH ST
WASHINGTON NC
27889-3591
US

V. Phone/Fax

Practice location:
  • Phone: 252-833-5245
  • Fax: 252-833-5244
Mailing address:
  • Phone: 252-833-5245
  • Fax: 252-833-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005890
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5005890
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: