1639933369 NPI number — CAMILLE BRIDGETTE WINSTEAD AGNP

Table of content: CAMILLE BRIDGETTE WINSTEAD AGNP (NPI 1639933369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639933369 NPI number — CAMILLE BRIDGETTE WINSTEAD AGNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINSTEAD
Provider First Name:
CAMILLE
Provider Middle Name:
BRIDGETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGNP
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:
1639933369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4845 JAMES TOWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27896-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-714-8966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CABARRUS AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-743-2247
Provider Business Practice Location Address Fax Number:
855-857-7333
Provider Enumeration Date:
02/13/2024

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: 363LP2300X , with the licence number:  5019626 , 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)





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