Provider Demographics
NPI:1073735726
Name:BRICE, KARON NMI
Entity Type:Individual
Prefix:MRS
First Name:KARON
Middle Name:NMI
Last Name:BRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:NC
Mailing Address - Zip Code:28478-7655
Mailing Address - Country:US
Mailing Address - Phone:910-285-3246
Mailing Address - Fax:910-285-6969
Practice Address - Street 1:570 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:NC
Practice Address - Zip Code:28478-7655
Practice Address - Country:US
Practice Address - Phone:910-285-3246
Practice Address - Fax:910-285-6969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-071-0063747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802012Medicaid