Healthcare Provider Details

I. General information

NPI: 1700069150
Provider Name (Legal Business Name): ALLIED PSYCHOPHYSIOLOGY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 EASTWOOD RD
WILMINGTON NC
28403-7228
US

IV. Provider business mailing address

PO BOX 754
WRIGHTSVILLE BEACH NC
28480-0754
US

V. Phone/Fax

Practice location:
  • Phone: 910-515-4200
  • Fax: 888-562-3550
Mailing address:
  • Phone:
  • Fax: 888-562-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ELIZABETH PORTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-515-4200