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General NPI Number Information
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NPI Number | 1720226236
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Entity Type | Organization
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Legal Business Name | PREMIER PEDIATRICS, PA
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 135 TURNER ST
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7054
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Country | US
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Telephone | 910-246-2229
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Fax | 910-246-0237
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Provider Business Mailing Address
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Address Line | 135 TURNER ST
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-7054
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Country | US
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Telephone | 910-246-2229
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Fax | 910-246-0237
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PETINA ANN SLOAN
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Credential |
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Telephone | 910-246-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 20070048
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License Number State | NC
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