=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679008288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERI WALLS FOLK NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2017
-----------------------------------------------------
Last Update Date | 12/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 CARTHAGE ST STE B
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27330-4161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-499-5150
-----------------------------------------------------
Fax | 919-499-0347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4546 NC 87 S
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27332-0212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-499-5150
-----------------------------------------------------
Fax | 919-499-0347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5009575
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 178795
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------