Provider Demographics
NPI:1740677921
Name:INNER BANKS FAMILY MEDICINE
Entity type:Organization
Organization Name:INNER BANKS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:252-217-2483
Mailing Address - Street 1:543 US HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-2144
Mailing Address - Country:US
Mailing Address - Phone:252-791-0993
Mailing Address - Fax:252-791-0996
Practice Address - Street 1:543 US HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-2144
Practice Address - Country:US
Practice Address - Phone:252-217-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty