Healthcare Provider Details

I. General information

NPI: 1497009617
Provider Name (Legal Business Name): ANGELICA SHAVER PRYOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANGELICA SHAVER

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 CULBRETH DR
WILMINGTON NC
28405-3639
US

IV. Provider business mailing address

PO BOX 538622
ATLANTA GA
30353-8622
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-9243
  • Fax: 888-746-1787
Mailing address:
  • Phone: 910-742-9243
  • Fax: 888-746-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005833
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5005833
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: