Provider Demographics
NPI:1740460492
Name:STROUD, GISELA ERNESTINE (NP-C)
Entity type:Individual
Prefix:
First Name:GISELA
Middle Name:ERNESTINE
Last Name:STROUD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8800
Mailing Address - Country:US
Mailing Address - Phone:252-523-0026
Mailing Address - Fax:252-523-1855
Practice Address - Street 1:744 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8800
Practice Address - Country:US
Practice Address - Phone:252-523-0026
Practice Address - Fax:252-523-1855
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC065962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0326OtherMEDICARE GROUP PTAN
NC1740460492OtherINVIDUAL NPI
NC8901960OtherGROUP MEDICAID
NC560989277OtherGROUPTAX ID
NC5908296OtherEASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR BEULAVILLE
NC14767405431OtherGROUP NPI
NC2593135Medicare PIN