Provider Demographics
NPI:1720556491
Name:SEASHORE FAMILY MEDICAL, PLLC
Entity Type:Organization
Organization Name:SEASHORE FAMILY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:RISING
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:910-575-0884
Mailing Address - Street 1:10195 BEACH DR SW
Mailing Address - Street 2:STE 5
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2757
Mailing Address - Country:US
Mailing Address - Phone:910-575-0884
Mailing Address - Fax:910-575-0197
Practice Address - Street 1:10195 BEACH DR SW STE 5
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2757
Practice Address - Country:US
Practice Address - Phone:910-575-0884
Practice Address - Fax:919-575-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-11
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty