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NPI Code Detail

MEDICARE: MRS. DAWN MARIE COULTHURST MASON PMHNP

MEDICARE:  MRS. DAWN MARIE COULTHURST MASON  PMHNP
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
1363LP0200XPediatric Nurse Practitioner5002208NC
2363L00000XNurse Practitioner5002208NC
3363LP0808XPsychiatric/Mental Health Nurse Practitioner5002208NC

General Provider Information

NPI Number : 1740408780
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DAWN MARIE COULTHURST MASON PMHNP
Provider Business Mailing Address
First Line : 1615 POLO RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-3831
Country : US
Telephone Number : 336-722-7226
Fax Number : 366-201-0538
Provider Business Practice Location Address
First Line : 1615 POLO RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-3831
Country : US
Telephone Number : 336-722-7266
Fax Number : 336-201-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 04/07/2026

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