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General NPI Number Information
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NPI Number | 1710529128
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Entity Type | Organization
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Legal Business Name | AHOSKIE MEDICAL PRACTICE, INC
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 703 CATHERINE CREEK RD S
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City | AHOSKIE
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State | NC
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Zip | 27910-3905
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Country | US
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Telephone | 252-209-0088
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Fax | 252-209-0088
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Provider Business Mailing Address
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Address Line | 114 BROWN RD
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City | COLERAIN
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State | NC
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Zip | 27924-9412
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Country | US
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Telephone | 252-209-0088
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Fax | 202-209-9024
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Authorized Official
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Title or Position | OWNER/ MID-LEVEL PROVIDER
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Name | MS. PENNY LYNN BROWN
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Credential | FNP
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Telephone | 252-209-0088
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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 |
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License Number State |
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