Provider Demographics
NPI:1942490370
Name:BRUMMETT, ATHENA C (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:C
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:114 CHARLOIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1522
Mailing Address - Country:US
Mailing Address - Phone:336-765-5470
Mailing Address - Fax:336-499-5428
Practice Address - Street 1:350 N COX ST
Practice Address - Street 2:NUMBER 20
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5566
Practice Address - Country:US
Practice Address - Phone:336-672-3200
Practice Address - Fax:336-629-7349
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2009-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC201700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2808309AMedicare UPIN