Dept of Veterans Affairs Outpatient Clinic

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

600091 Issued in NC

Legal business name

DEPT OF VETERANS AFFAIRS OUTPATIENT CLINIC

Practice address

190 Kimel Park Dr
Winston-Salem, NC 27103-6946

Phone

(336) 768-7696

NPI assigned

Mar 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Stephrn Buettle, MD

Title

Chief of Staff

Phone

(336) 768-3296

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538120910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-768-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-768-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPT OF VETERANS AFFAIRS OUTPATIENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUETTLE",
        "authorized_official_first_name": "STEPHRN",
        "authorized_official_title_or_position": "CHIEF OF STAFF",
        "authorized_official_telephone_number": "336-768-3296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "600091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Annette Denton, FNP
• Martha Jo Denton, NP
• Staci R Denton
• Joel Krishna Deonanan, M.D.
• Department of Veterans Affairs
• Derek'S Place
• Derek'S Place 2
• Alexander Dergins
• Christine Derisse
• Natalie Simone Deroche

• Adult Health Nurse Practitioner in Winston-Salem, NC
• Providers in Winston-Salem, NC by specialty
• Adult Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.