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 | 207Q00000X | Family Medicine | | | | No |
| 2 | 261QH0100X | Clinic/Center | Health Service | | | No |
| 3 | 1041C0700X | Social Worker | Clinical | | | No |
| 4 | 133V00000X | Dietitian, Registered | | | | No |
| 5 | 261QP2300X | Clinic/Center | Primary Care | | NORTH CAROLINA | No |
| 6 | 261QP0905X | Clinic/Center | Public Health, State or Local | | 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 | 2803148 | OTHER | NORTH CAROLINA | MEDICARE ROSTER BILLING |
| 2 | 2994347 | OTHER | NORTH CAROLINA | MEDICARE(NUTRITION) |
| 3 | 9017814 | OTHER | NORTH CAROLINA | CIGNA HEALTHCARE |
| 4 | 022K2 | OTHER | NORTH CAROLINA | BCBS NUTRITION |
| 5 | 3404475 | MEDICAID | NORTH CAROLINA | |
| 6 | 022PN | OTHER | NORTH CAROLINA | BCBS NC (IMMUNIZING HEALTH CENTER) |
| 7 | 025CT(PRIMARY CARE) | OTHER | NORTH CAROLINA | BCBS |
