Provider Demographics
NPI:1255566154
Name:GORE, TEDDIE WAYNE (FNP)
Entity type:Individual
Prefix:MR
First Name:TEDDIE
Middle Name:WAYNE
Last Name:GORE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8423
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8423
Mailing Address - Country:US
Mailing Address - Phone:252-847-2181
Mailing Address - Fax:252-847-2213
Practice Address - Street 1:2100 STANTONSBURG ROAD
Practice Address - Street 2:ECHI AT PCMH
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27835
Practice Address - Country:US
Practice Address - Phone:252-847-2181
Practice Address - Fax:252-847-2213
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily