Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 208000000X | Pediatrics | | 9701818 | NORTH CAROLINA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 810561334 | OTHER | NORTH CAROLINA | WELLPATH SELECT INC |
| 2 | 810561334 | OTHER | KENTUCKY | HEALTHNET OF CA |
| 3 | 9259849 | OTHER | MASSACHUSETTS | PHCS |
| 4 | 810561334 | OTHER | NORTH CAROLINA | SOUTHCARE PPO INC |
| 5 | A8078 | OTHER | NORTH CAROLINA | MEDCOST |
| 6 | 12-01098 | OTHER | NORTH CAROLINA | UNITED HEALTHCARE |
| 7 | 1322Y | OTHER | NORTH CAROLINA | BLUECROSS BLUESHIELD |
| 8 | 810561334 | OTHER | NORTH CAROLINA | PRIMARY PHYSCIAIN CARE |
| 9 | 810561334 | OTHER | NORTH CAROLINA | HEALTHCARE SAVINGS |
| 10 | 810561334 | OTHER | TENNESSEE | NORTH AMERICA ADMIN LP |
| 11 | 2900124 | OTHER | NORTH CAROLINA | AETNA |
| 12 | 810561334 | OTHER | SOUTH CAROLINA | TRICARE |
| 13 | 810561334 | OTHER | KANSAS | ONE HEALTH |
| 14 | 9554744001 | OTHER | NORTH CAROLINA | CIGNA |
| 15 | 891322Y | MEDICAID | NORTH CAROLINA | |
| 16 | 1322Y | OTHER | NORTH CAROLINA | STATE HEALTH PLAN NC |
| 17 | 810561334 | OTHER | SOUTH CAROLINA | HEALTHSOURCE OF NC |
| 18 | 810561334 | OTHER | NORTH CAROLINA | PREMIER HEALTH SYSTEMS |
