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General NPI Number Information
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NPI Number | 1689170037
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Entity Type | Individual
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Provider Name | WILLIE KAY MCDUFFIE RN
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 114 FORTE RD
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City | STEDMAN
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State | NC
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Zip | 28391
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Country | US
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Telephone | 910-615-3410
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 328
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-0328
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Country | US
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Telephone | 910-640-9203
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Fax |
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 152855
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 152855
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License Number State | NC
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