MEDICARE: BETH FARMER BLAIR WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	144820	NC
2	363LW0102X	Women's Health Nurse Practitioner	5006313	NC

General Provider Information

NPI Number	:	1033551262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH FARMER BLAIR WHNP

Provider Business Mailing Address
First Line	:	210 13TH AVENUE PL NW
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2568
Country	:	US
Telephone Number	:	828-322-3017
Fax Number	:	828-322-1087

Provider Business Practice Location Address
First Line	:	210 13TH AVENUE PL NW
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2568
Country	:	US
Telephone Number	:	828-322-3017
Fax Number	:	828-322-1087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	07/30/2013

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