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General NPI Number Information
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NPI Number | 1740677921
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Entity Type | Organization
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Legal Business Name | INNER BANKS FAMILY MEDICINE
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 543 US HIGHWAY 64 W
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City | PLYMOUTH
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State | NC
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Zip | 27962-2144
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Country | US
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Telephone | 252-217-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 543 US HIGHWAY 64 W
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City | PLYMOUTH
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State | NC
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Zip | 27962-2144
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Country | US
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Telephone | 252-791-0993
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Fax | 252-791-0996
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | RENEA PRICE
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Credential | FNP-C
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Telephone | 252-217-2483
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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 | 5004780
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License Number State | NC
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