MEDICARE: KIARA WINSOR FNP-BC

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	363LF0000X	Family Nurse Practitioner	4704303022	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4704303022	OTHER	MI	STATE PROFESSIONAL LICENSE

General Provider Information

NPI Number	:	1316474158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA WINSOR FNP-BC

Provider Business Mailing Address
First Line	:	2005 PISGAH CHURCH RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3309
Country	:	US
Telephone Number	:	336-716-9150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 PISGAH CHURCH RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3309
Country	:	US
Telephone Number	:	336-716-9150
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/14/2020

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