MEDICARE: DLP HICKORY FAMILY PRACTICE ASSOCIATES LLC

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
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1396100871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DLP HICKORY FAMILY PRACTICE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	52 12TH AVE NE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2798
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 12TH AVE NE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2798
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESS N JUDY
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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