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General NPI Number Information
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NPI Number | 1801514922
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Entity Type | Individual
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Provider Name | CARRIE MAE CLOUGH FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1248 FORT BRAGG RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-4981
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Country | US
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Telephone | 910-323-0334
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Fax | 910-676-7340
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Provider Business Mailing Address
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Address Line | 1248 FORT BRAGG RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-4981
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Country | US
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Telephone | 910-323-0334
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Fax | 910-676-7340
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5016749
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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 | 5016749
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License Number State | NC
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