MEDICARE: BROOKS EDWARDS SCURRY FNP-BC

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	5011722	NC

General Provider Information

NPI Number	:	1831753763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKS EDWARDS SCURRY FNP-BC

Provider Business Mailing Address
First Line	:	193 W SUMMIT AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4448
Country	:	US
Telephone Number	:	803-767-3052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2809 COLTSGATE RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-5583
Country	:	US
Telephone Number	:	704-733-9202
Fax Number	:

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/18/2023

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