Provider Demographics
NPI:1043238587
Name:FREDERICK, SUSAN FLOWERS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FLOWERS
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6740
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:152 CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8800
Practice Address - Country:US
Practice Address - Phone:910-298-4688
Practice Address - Fax:910-298-4628
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006004306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1653JOtherBCBSNC
NC1653JOtherBCBSNC
NC8901960OtherEASTERN CAROLINA PHYSICIANS GROUP MEDICAID NUMBER FOR KINSTON
NC5908296OtherEASTERN CAROLINA PHYSICIANS GROUP MEDICAID NUMBER FOR BEULAVILLE
1467405431OtherGROUP NPI NUMBER
NCQ72969Medicare UPIN
NC7006176Medicaid
NC1653JOtherBCBSNC