Provider Demographics
NPI:1033278163
Name:NAYLOR, JENTRY ELLON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENTRY
Middle Name:ELLON
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 STRAW POND SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28366-6777
Mailing Address - Country:US
Mailing Address - Phone:910-567-2709
Mailing Address - Fax:
Practice Address - Street 1:2809 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1647
Practice Address - Country:US
Practice Address - Phone:919-580-9840
Practice Address - Fax:919-580-9838
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2313887AMedicare PIN
NCP58418Medicare UPIN