Provider Demographics
NPI:1073000816
Name:WYNES, CARMEN M (NP)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:M
Last Name:WYNES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:109 CURRITUCK COMMERICAL DR
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-9066
Mailing Address - Country:US
Mailing Address - Phone:252-435-1001
Mailing Address - Fax:252-253-6203
Practice Address - Street 1:109 CURRITUCK COMMERICAL DR STE A
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-9068
Practice Address - Country:US
Practice Address - Phone:252-435-1001
Practice Address - Fax:252-394-2223
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175910363LF0000X
NCWYNE-WLK81363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750021325Medicaid