| Wilmington Family Practice Pllc | |
|
201 N Front St Suite 102 Wilmington NC 28401-4055 | |
| (910) 500-6451 | |
| (910) 500-6478 |
| Full Name | Wilmington Family Practice Pllc |
|---|---|
| Speciality | Physician Assistant |
| Location | 201 N Front St, Wilmington, North Carolina |
| Authorized Official Name and Position | Tina Louise Hudson (PRACTICE MANAGER) |
| Authorized Official Contact | 9105006451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilmington Family Practice Pllc 201 N Front St Suite 102 Ll Wilmington NC 28401-4055 Ph: (910) 500-6451 | Wilmington Family Practice Pllc 201 N Front St Suite 102 Wilmington NC 28401-4055 Ph: (910) 500-6451 |
| NPI Number | 1992351910 |
|---|---|
| Provider Enumeration Date | 08/15/2019 |
| Last Update Date | 02/11/2020 |
| Medicare PECOS PAC ID | 6800222969 |
|---|---|
| Medicare Enrollment ID | O20200207002349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992351910 | NPI | - | NPPES |
| Provider Name | Patricia A Odham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750457024 PECOS PAC ID: 9234237801 Enrollment ID: I20071109000131 |
| Provider Name | Edward Marvin Mckeithan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821295668 PECOS PAC ID: 5799830501 Enrollment ID: I20090918000218 |
| Provider Name | Andrea Petrone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841578424 PECOS PAC ID: 7113197989 Enrollment ID: I20110906000000 |
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