Basic Information
| Provider Information | |||||||||
| NPI: | 1124790985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAME | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | GILBERT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GILBERT | ||||||||
| OtherFirstName: | HANNAH | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 864 BLACK CREEK RD | ||||||||
| Address2: | |||||||||
| City: | FOUR OAKS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275248314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199633148 | ||||||||
| FaxNumber: | 9199632900 | ||||||||
| Practice Location | |||||||||
| Address1: | 864 BLACK CREEK RD | ||||||||
| Address2: | |||||||||
| City: | FOUR OAKS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275248314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199633148 | ||||||||
| FaxNumber: | 9199632900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2021 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0010-12050 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.