Healthcare Provider Details

I. General information

NPI: 1942655071
Provider Name (Legal Business Name): PENNY NOAH PHLEGAR AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4937 OLD COUNTRY CLUB RD
WINSTON SALEM NC
27104-5071
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-4510
  • Fax: 336-718-4519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008503
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: