Provider Demographics
NPI:1205839529
Name:ERVIN, VIRGINIA BAITY (MSN, APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:BAITY
Last Name:ERVIN
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3413
Mailing Address - Country:US
Mailing Address - Phone:704-739-5550
Mailing Address - Fax:800-317-3563
Practice Address - Street 1:108 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3413
Practice Address - Country:US
Practice Address - Phone:704-739-5550
Practice Address - Fax:800-317-3563
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45500Medicare UPIN