Timothy Wayne Umphlett Sr., NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5013703 Issued in NC

Practice address

104 Rhodes Ave
Windsor, NC 27983-9656

Phone

(252) 794-3042

Fax

(252) 794-2911

NPI assigned

Oct 30, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Tim Wayne Umphlett Sr. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bertie County Rural Health Association

  • Clinic Pharmacy
  • Windsor, NC
  • NPI 1801427711
  NPD

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1922608686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 628",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279830628",
            "telephone_number": "252-794-3042",
            "fax_number": "252-794-2911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 RHODES AVE",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279839656",
            "telephone_number": "252-794-3042",
            "fax_number": "252-794-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UMPHLETT",
        "first_name": "TIMOTHY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5013703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIM",
            "last_name": "UMPHLETT",
            "middle_name": "WAYNE",
            "prefix": "MR.",
            "suffix": "SR.",
            "credential": "NURSE PRACTITIONER",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Touching Lives, Inc
• Touching Lives, Inc.
• Touching Lives,Inc
• Touching Lives,Inc
• Chamberlee Miller Trowell, L.P.A.
• Uplift Comprehensive Services
• Uplift Comprehensive Services
• Uplift Comprehensive Services
• Uplift Comprehensive Services
• Uplift Comprehensive Services

• Family Nurse Practitioner in Windsor, NC
• Providers in Windsor, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.