Provider Demographics
NPI:1205914512
Name:WOMBLE, CAROL (FNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:FNP
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-643-5800
Mailing Address - Fax:336-643-7474
Practice Address - Street 1:6161 LAKE BRANDT RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8414
Practice Address - Country:US
Practice Address - Phone:336-643-5800
Practice Address - Fax:336-643-7474
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000201015363LF0000X
NC201015363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005697Medicaid
NC2591537CMedicare PIN
NC500008827Medicare PIN
NC7005697Medicaid
NC2591537AMedicare PIN