MEDICARE: THERESA MCNEILL CARMON

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	5024536	NC

General Provider Information

NPI Number	:	1336078658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MCNEILL CARMON

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 S MAIN ST STE A
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5011
Country	:	US
Telephone Number	:	919-229-4833
Fax Number	:

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	06/20/2026

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Directions to “ THERESA MCNEILL CARMON ” Practice Location

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