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General NPI Number Information
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NPI Number | 1184114118
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Entity Type | Organization
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Legal Business Name | INTEGRATED PSYCHOGENIC WELLNESS ASSOCIATES
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 1205 W BESSEMER AVE # 1213
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City | GREENSBORO
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State | NC
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Zip | 27408-8442
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Country | US
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Telephone | 336-736-1452
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Fax |
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Provider Business Mailing Address
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Address Line | 2672 SPLITBROOK DR
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City | HIGH POINT
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State | NC
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Zip | 27265-7980
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | EVANNA BURKETT
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Credential | RN, FNP-C, DNP
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Telephone | 336-736-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 210912
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License Number State | NC
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