Provider Demographics
NPI:1598958621
Name:MICHAEL K NUNN, PC
Entity Type:Organization
Organization Name:MICHAEL K NUNN, PC
Other - Org Name:COMMUNITY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:YALDEN
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-634-2900
Mailing Address - Street 1:750 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5233
Mailing Address - Country:US
Mailing Address - Phone:252-633-6636
Mailing Address - Fax:252-634-2920
Practice Address - Street 1:750 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5233
Practice Address - Country:US
Practice Address - Phone:252-633-6636
Practice Address - Fax:252-634-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC361232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890167HMedicaid
NC0167HOtherBCBS OF NC
NC2321266Medicare PIN
NCF43647Medicare UPIN