Provider Demographics
NPI:1710529128
Name:AHOSKIE MEDICAL PRACTICE, INC
Entity Type:Organization
Organization Name:AHOSKIE MEDICAL PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MID-LEVEL PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:252-209-0088
Mailing Address - Street 1:114 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-9412
Mailing Address - Country:US
Mailing Address - Phone:252-209-0088
Mailing Address - Fax:202-209-9024
Practice Address - Street 1:703 CATHERINE CREEK RD S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3905
Practice Address - Country:US
Practice Address - Phone:252-209-0088
Practice Address - Fax:252-209-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty