MEDICARE: MRS. CINDY A COMPEGGIE

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	363L00000X	Nurse Practitioner	300136	NC
2	363L00000X	Nurse Practitioner	134636	NC
3	363LP0200X	Pediatric Nurse Practitioner	300136	NC

General Provider Information

NPI Number	:	1205899713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CINDY A COMPEGGIE

Provider Business Mailing Address
First Line	:	PO BOX 986513
Second Line	:	DEPARTMENT 100
City	:	BOSTON
State	:	MA
Zip	:	02298-6513
Country	:	US
Telephone Number	:	910-219-8326
Fax Number	:	910-939-4269

Provider Business Practice Location Address
First Line	:	120 MEMORIAL DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6328
Country	:	US
Telephone Number	:	910-353-0581
Fax Number	:	910-353-1351

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	11/03/2023

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