=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801143805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILSON COMMUNITY FAMILY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2012
-----------------------------------------------------
Last Update Date | 01/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 BRENTWOOD CENTER LN N
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27896-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-991-5382
-----------------------------------------------------
Fax | 252-991-5381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 BRENTWOOD CENTER LN N
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27896-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-991-5382
-----------------------------------------------------
Fax | 252-991-5381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NURSE PRACTITIONER
-----------------------------------------------------
Name | JANELLE BROWN-TAFT
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 252-991-5382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 5004688
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------