MEDICARE: AVERY CARRIGAN FNP

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	291916	NC

General Provider Information

NPI Number	:	1427618248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY CARRIGAN FNP

Provider Business Mailing Address
First Line	:	5085 WYNGATE VILLAGE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5253
Country	:	US
Telephone Number	:	423-612-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	5085 WYNGATE VILLAGE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5253
Country	:	US
Telephone Number	:	423-612-3570
Fax Number	:

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	06/28/2022

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