Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 143931 | NC |
Y | 363L00000X | Nurse Practitioner | 200786 | NC |
NPI | 1003889080 |
---|---|
Provider Name | Mr. John Hudson Fillmore |
First Address | Charlotte, NC 28260-0447 |
Second Address | Shallotte, NC 28470-6503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0131P | BLUE CROSS BLUE SHIELD (01) | |
2592037 | CIGNA MEDICARE (01) | |
348906A | (05) | NC |
7005644 | (05) | NC |
P00188452 | RAILROAD MEDICARE (01) | |
Q08661 | (02) |