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General NPI Number Information
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NPI Number | 1427356153
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Entity Type | Individual
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Provider Name | JOAN PRIDDY-SOUTHERN NP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 145 KIMEL PARK DR SUITE 330
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6984
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Country | US
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Telephone | 336-765-6181
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Fax | 336-714-6481
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Provider Business Mailing Address
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Address Line | 145 KIMEL PARK DR SUITE 330
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6984
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Country | US
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Telephone | 336-765-6181
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Fax | 336-714-6481
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 83415
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License Number State | NC
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