Wilmington Family Practice PLLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

WILMINGTON FAMILY PRACTICE PLLC

Practice address

201 N Front St
Suite 102
Wilmington, NC 28401-4055

Phone

(910) 500-6451

Fax

(910) 500-6478

NPI assigned

Aug 15, 2019

Last updated

Feb 11, 2020By 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

Tina Louise Hudson

Title

Practice Manager

Phone

(910) 500-6451

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edward Marvin McKeithan, NP

  • Family Nurse Practitioner
  • Bolivia, NC
  • NPI 1821295668
  Medicare reassignment NPD
• Patricia A Odham, FNP

  • Family Nurse Practitioner
  • Wilmington, NC
  • NPI 1750457024
  Medicare reassignment NPD
• Andrea G Petrone, FNP

  • Family Nurse Practitioner
  • Asheville, NC
  • NPI 1841578424
  Medicare reassignment NPD
• Max Brandon Ludlum, PA-C

  • Physician Assistant
  • Wilmington, NC
  • NPI 1669918223
  Medicare reassignment
• Jaime Allison Snyder, PMHNP, FNP, CARN-AP

  • Psychiatric/Mental Health Nurse Practitioner
  • Charlotte, NC
  • NPI 1962844902

  Family

  NPD (past)

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1992351910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N FRONT ST",
            "address_2": "SUITE 102 LL",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014055",
            "telephone_number": "910-500-6451",
            "fax_number": "910-500-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N FRONT ST",
            "address_2": "SUITE 102",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014055",
            "telephone_number": "910-500-6451",
            "fax_number": "910-500-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "910-500-6451"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wilmington Fertility Center PLLC
• Wilmington Gastroenterology Associates,PA
• Wilmington Gastroenterology Endoscopy Center, Inc
• Wilmington Hand Therapy Limited Partnership (Hand Therapy of Wilmington)
• Wilmington Healing With Hope

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.