Elizabeth Marlo McCullen Fann

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5022764 Issued in NC

Practice address

192 Village Dr
Jacksonville, NC 28546-7238

Phone

(910) 577-1400

NPI assigned

Aug 2, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elizabeth Marlo McCullen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1754092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1932083011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 HINSON RD",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "283349583",
            "telephone_number": "910-990-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 VILLAGE DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467238",
            "telephone_number": "910-577-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANN",
        "first_name": "ELIZABETH",
        "middle_name": "MARLO MCCULLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-02",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5022764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "MCCULLEN",
            "middle_name": "MARLO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; 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.