Provider Demographics
NPI:1932287232
Name:SPINKS, CARROLL CONNER (NP)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:CONNER
Last Name:SPINKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-297-2251
Mailing Address - Fax:336-297-2260
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-274-3241
Practice Address - Fax:336-544-2343
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600067363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83808Medicare UPIN
NC2807832Medicare PIN