SIMPLECLINIC PLLC NPI 1255998944

NPI Information

NPI: 1255998944
Provider Name: SIMPLECLINIC PLLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 34D2122092

Address:
1515 SUNSET AVE
CLINTON, NC
ZIP 28328
Phone: (910) 491-9418
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SIMPLECLINIC PLLC is a primary care nurse practitioner in Clinton, NC. SIMPLECLINIC PLLC NPI is 1255998944. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1515 SUNSET AVE
CLINTON, NC
ZIP 28328-827
Phone: (910) 491-9418
Fax: (866) 488-6433

The provider's authorized official is Jonathan Daniel Hancock .
The authorized official title is Owner/provider and has the following contact phone number (910) 491-4530.

The CLIA number assigned to this NPI record is 34D2122092 - practitioner other with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/29/2019 and was last updated on 5/31/2019.

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	363LP2300X	Nurse Practitioner	Primary Care			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	PENDING	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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