=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679627293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN TYRRELL WASHINGTON DISTRICT HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 198 NC HIGHWAY 45 N
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27962-9232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-793-3023
-----------------------------------------------------
Fax | 252-791-3159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 NC HIGHWAY 45 N
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27962-9232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-793-3023
-----------------------------------------------------
Fax | 252-791-3159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH DIRECTOR
-----------------------------------------------------
Name | KATHLEEN D JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-793-3023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------