Healthcare Provider Details

I. General information

NPI: 1689560849
Provider Name (Legal Business Name): CHRISTY WOOLARD HOUSE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PARK ST
WILLIAMSTON NC
27892-2769
US

IV. Provider business mailing address

958 US HIGHWAY 64 E
PLYMOUTH NC
27962-9216
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-7690
  • Fax:
Mailing address:
  • Phone: 252-793-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022377
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: