MRS. KOMKWUAN PHOLTAVEE PARUCHABUTR (NPI# 1689976367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689976367 |
| Entity Type | Individual |
| Full Name | MRS. KOMKWUAN PHOLTAVEE PARUCHABUTR |
| Credential | WHNP-BC, FNP-BC |
| Practice Address |
Building 4-2817 Reilly Road Fort Bragg NC 28307 |
| Mailing Address |
2426 Market Hill Dr Fayetteville NC 28306-7495 |
| Practice Telephone | 9109076000 |
| Mailing Telephone | 8636704681 |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2012-05-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WW0101X |
Registered Nurse Specialization: Women's Health Care, Ambulatory |
207275 | NC | Nursing Service Providers |
| Street Address |
BUILDING 4-2817 REILLY ROAD |
| City | FORT BRAGG |
| State | NC |
| Zip Code | 28307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700498631 | Jaclyn Jennifer Willis | Dentist | Ardennes Street, Fort Bragg, NC 28307 | 2020-08-21 |
| 1003398850 | Bailey Moorhead | Dentist | Bldg C-6238 Ardennes Road, Fort Bragg, NC 28307 | 2018-08-29 |
| 1619454980 | Seth David Williams | Physician Assistant | Bldg C-1722 Tagatay Dr, Fort Bragg, NC 28307 | 2018-07-19 |
| 1134633894 | Ashley Andrick | Physician Assistant | 1722 Tagatay Dr, Fort Bragg, NC 28307 | 2017-11-16 |
| 1184144479 | Thomas William Hanna IIi | Dentist | Bldg C-6238 Ardennes St., Fort Bragg, NC 28307 | 2017-06-27 |
| 1720530355 | Robert Holly | Military Health Care Provider | 7606 Reilly Rd, Bldg 2, Fort Bragg, NC 28307 | 2016-10-31 |
| 1891246708 | Womack Army Medical Center | Pharmacy | 1571 Reilly Rd, Bldg 4, Ft Bragg, NC 28307 | 2016-10-17 |
| 1710319405 | Valerie D. Jefferys | Pharmacist | 2817 Reily Road Womack Army Medical Center, Apo, AE 28307 | 2013-08-05 |
| 1609032879 | Kristi Lyn Natalino | Physical Therapist | 2817 Reilly Rd Bldg 4, Physical Therapy Department, Fort Bragg, NC 28307 | 2008-08-06 |
| 1841465051 | Mary Thomas Plunkett | Internal Medicine | Building 4-2817 Reilly Road Womack Army Medical Center, Internal Medicine Dept - Fort Bragg, Fayetteville, NC 28307 | 2008-04-29 |
| Find all providers in zip 28307 | ||||
| Taxonomy Code | 163WW0101X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Women's Health Care, Ambulatory |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174624001 | Tammy Stahlman | Registered Nurse | 991 Huson Blvd., Gastonia, NC 28052 | 2006-09-25 |
| 1417983420 | Sally A Joseph | Registered Nurse | 5015 Southpark Dr, Durham, NC 27713-7736 | 2006-06-23 |
| 1184623415 | Mackenzie Day Watkins | Registered Nurse | 2001 Todays Woman Ave, Winston Salem, NC 27105-5069 | 2005-07-19 |
| 1093711798 | Pamela King Hester | Registered Nurse | 218 Doggett Rd, Forest City, NC 28043-8203 | 2005-06-27 |
| 1114568714 | Rachael Alexander | Registered Nurse | 1765 Dobbins Dr, Chapel Hill, NC 27514-5876 | 2019-10-04 |
| 1831612779 | Heather R Flowers | Registered Nurse | 550 New Waverly Pl, Cary, NC 27518-7412 | 2017-07-24 |
| 1730541350 | Donna Biggs | Registered Nurse | 1100 E Wendover Ave, Greensboro, NC 27405-6713 | 2016-03-23 |
| 1922464312 | Glenda Graves | Registered Nurse | 1100 E Wendover Ave, Greensboro, NC 27405-6713 | 2016-01-14 |
| 1891112660 | Linda Kinney | Registered Nurse | 991 W Hudson Blvd, Gastonia, NC 28052-6430 | 2014-03-18 |
| 1174953889 | Japhine Floyd | Registered Nurse | 991 W Hudson Blvd, Gastonia, NC 28052-6430 | 2013-11-15 |
| Find all providers with the same taxonomy | ||||
| City | FORT BRAGG |
| Zip Code | 28307 |
Please comment or provide details below to improve the information on MRS. KOMKWUAN PHOLTAVEE PARUCHABUTR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.