Provider Demographics
NPI:1801143805
Name:WILSON COMMUNITY FAMILY PRACTICE
Entity type:Organization
Organization Name:WILSON COMMUNITY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:252-991-5382
Mailing Address - Street 1:114 BRENTWOOD CENTER LN N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1710
Mailing Address - Country:US
Mailing Address - Phone:252-991-5382
Mailing Address - Fax:252-991-5381
Practice Address - Street 1:114 BRENTWOOD CENTER LN N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1710
Practice Address - Country:US
Practice Address - Phone:252-991-5382
Practice Address - Fax:252-991-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004688261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center