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NPI Code Detail

MEDICARE: MR. JUSTIN FLETCHER SEGREST FNP, MSN, RN

MEDICARE: MR. JUSTIN FLETCHER SEGREST FNP, MSN, RN
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
1363L00000XNurse Practitioner5005952NC
2363LF0000XFamily Nurse Practitioner5005952NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477842987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN FLETCHER SEGREST FNP, MSN, RN
Provider Business Mailing Address
First Line : 2770 LEWISVILLE CLEMMONS RD
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8716
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2770 LEWISVILLE CLEMMONS RD
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8716
Country : US
Telephone Number : 336-766-0324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2011
Last Update Date : 09/28/2017

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