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Organization
MY PEACE KEEPER INC
Active
Organization
MY PEACE KEEPER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIRGINIA B POUGH BA (EXECUTIVE DIRECTOR)
(704) 531-5656
Entity
Organization
Contact information
Practice address
7504 E INDEPENDENCE BLVD STE 101, CHARLOTTE, NC 28227-9407
(704) 531-5656
(704) 531-9711
Mailing address
7504 E INDEPENDENCE BLVD STE 101, CHARLOTTE, NC 28227-9407
(704) 531-5656
(704) 531-9711
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
364SP0810X
Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Enumeration date
12/21/2009
Last updated
12/21/2009
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