Fayetteville State University

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

FAYETTEVILLE STATE UNIVERSITY

Practice address

1200 Murchison Road
Student Health Services
Fayetteville, NC 28301-4252

Phone

(910) 672-2602

Fax

(910) 672-1366

NPI assigned

Jul 31, 2018

Last updated

Nov 24, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ieschecia Nytonya Graham Allen, MS, RHIT

Title

Executive Director

Phone

(910) 672-2602

Specialties & licenses 1

Addresses

Other names 1

• Student Health Services Other name

Tax ID family

Fayetteville State University2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fayetteville State University

  • Clinic Pharmacy
  • Fayetteville, NC
  • NPI 1528547718
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700784000000",
    "number": "1063990281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MURCHISON ROAD",
            "address_2": "STUDENT HEALTH SERVICES",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014252",
            "telephone_number": "910-672-2602",
            "fax_number": "910-672-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MURCHISON ROAD",
            "address_2": "STUDENT HEALTH SERVICES",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014252",
            "telephone_number": "910-672-2602",
            "fax_number": "910-672-1366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-31",
        "last_updated": "2023-11-24",
        "status": "A",
        "authorized_official_last_name": "GRAHAM ALLEN",
        "authorized_official_first_name": "IESCHECIA",
        "authorized_official_middle_name": "NYTONYA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-672-2602",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, RHIT"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Student Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Fayetteville Otolaryngology Head and Neck Surgery PA
• Fayetteville Physical Therapy & Rehab LLC
• Fayetteville Plastic Surgery Specialists, PA
• Fayetteville Pulmonology Critical Care PC
• Fayetteville Sleep Appliances LLC
• Fayetteville State University
• Fayetteville State University
• Fayetteville State University/Dept of Nursing
• Fayetteville Urgent Care and Family Medicine PA
• Fayetteville Urology Associates PA

• Health Service Clinic/Center in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Health Service Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.