Basic Information
| Provider Information | |||||||||
| NPI: | 1891049243 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOMETOWN PRIMARY CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | KENANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283490009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102750195 | ||||||||
| FaxNumber: | 9102750192 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 N MAIN STREET | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | KENANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283490001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102750195 | ||||||||
| FaxNumber: | 9102750192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2012 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOLLAND | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9102750195 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.