1013547553 NPI number — BRENDA CHERYL FORE FNP-BC

Table of content: BRENDA CHERYL FORE FNP-BC (NPI 1013547553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013547553 NPI number — BRENDA CHERYL FORE FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORE
Provider First Name:
BRENDA
Provider Middle Name:
CHERYL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013547553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYSON CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28713-0406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-560-3400
Provider Business Mailing Address Fax Number:
828-538-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
997 OLD US HWY 70 W STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28711-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-298-7981
Provider Business Practice Location Address Fax Number:
828-298-6010
Provider Enumeration Date:
01/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  5012974 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NNB202A . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2089V . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P02457852 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1013547553 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2776095 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".