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General NPI Number Information
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NPI Number | 1821959610
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA HEALTH CARE PA
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 4252 ARENDELL ST STE H
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City | MOREHEAD CITY
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State | NC
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Zip | 28557-0015
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Country | US
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Telephone | 252-672-4840
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12248
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City | NEW BERN
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State | NC
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Zip | 28561-2248
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Country | US
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Telephone | 252-514-2061
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Fax | 252-514-2745
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Authorized Official
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Title or Position | CEO
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Name | STEPHEN WITHEROW NUCKOLLS
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Credential |
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Telephone | 252-514-6685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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