MEDICARE: MRS. CARRIE DENISE FERNALD N.P.

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	363LG0600X	Gerontology Nurse Practitioner	5003982	NC

General Provider Information

NPI Number	:	1912172081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE DENISE FERNALD N.P.

Provider Business Mailing Address
First Line	:	4745 CENTURY OAKS LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-8719
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 KIMEL FOREST DR STE 100
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6084
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	02/19/2025

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