Provider Demographics
NPI:1235595927
Name:THE CLINIC AT WALMART
Entity Type:Organization
Organization Name:THE CLINIC AT WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:910-736-7002
Mailing Address - Street 1:341 SANDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-6469
Mailing Address - Country:US
Mailing Address - Phone:910-736-7002
Mailing Address - Fax:
Practice Address - Street 1:5070 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2108
Practice Address - Country:US
Practice Address - Phone:910-739-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196391261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care