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General NPI Number Information
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NPI Number | 1508300880
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Entity Type | Organization
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Legal Business Name | COUNTRY PRIMARY CARE
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 8409 W HILDY CT
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-3623
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Country | US
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Telephone | 540-809-4454
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Fax |
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Provider Business Mailing Address
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Address Line | 8409 W HILDY CT
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-3623
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Country | US
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Telephone | 540-809-4454
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Fax |
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Authorized Official
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Title or Position | CHIEF NURSE PRACTITIONER
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Name | MS. PAMELA SUE KELLER-ARLEDGE
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Credential | FNP-BC
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Telephone | 540-809-4454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0024169540
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License Number State | VA
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