Provider Demographics
NPI:1326739558
Name:VOIGT, DESIRAE JO (PNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:DESIRAE
Middle Name:JO
Last Name:VOIGT
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 BEDROCK RD
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:NC
Mailing Address - Zip Code:27283-9218
Mailing Address - Country:US
Mailing Address - Phone:336-908-3005
Mailing Address - Fax:
Practice Address - Street 1:2005 PISGAH CHURCH RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3309
Practice Address - Country:US
Practice Address - Phone:336-716-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018086363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics