Provider Demographics
NPI:1699830711
Name:YANCEYVILLE PRIMARY CARE PA
Entity Type:Organization
Organization Name:YANCEYVILLE PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:336-694-6969
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-0608
Mailing Address - Country:US
Mailing Address - Phone:336-694-6969
Mailing Address - Fax:336-694-1266
Practice Address - Street 1:1499 MAIN STREET
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379
Practice Address - Country:US
Practice Address - Phone:336-694-6969
Practice Address - Fax:336-694-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342634Medicare PIN