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General NPI Number Information
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NPI Number | 1477789147
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Entity Type | Organization
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Legal Business Name | GREENBRIAR PRIMARY CARE, PA
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 308-C MOCKSVILLE HIGHWAY
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City | STATESVILLE
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State | NC
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Zip | 28625
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Country | US
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Telephone | 704-873-4484
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Fax | 704-873-4485
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Provider Business Mailing Address
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Address Line | 308-C MOCKSVILLE HIGHWAY
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City | STATESVILLE
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State | NC
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Zip | 28625-8267
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Country | US
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Telephone | 704-873-4484
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Fax | 704-873-4485
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUDY L KEIGHRON
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Credential | NP
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Telephone | 704-873-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201255
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License Number State | NC
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