Provider Demographics
NPI:1235682022
Name:PLEASURE ISLAND HEALTH
Entity Type:Organization
Organization Name:PLEASURE ISLAND HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:910-399-8666
Mailing Address - Street 1:1328 NORTH LAKE PARK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428
Mailing Address - Country:US
Mailing Address - Phone:910-399-8666
Mailing Address - Fax:910-399-8664
Practice Address - Street 1:1328 NORTH LAKE PARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428
Practice Address - Country:US
Practice Address - Phone:910-399-8666
Practice Address - Fax:910-399-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004456207R00000X
NC190386363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty