Individual
MR. JOHN HUDSON FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
640 WHITEVILLE RD NW, SHALLOTTE, NC 28470-6503
(910) 754-4441
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 754-4441
(910) 754-5307
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200786
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131P
BLUE CROSS BLUE SHIELD
—
01
—
2592037
CIGNA MEDICARE
—
05
—
348906A
—
NC
05
—
7005644
—
NC
01
—
P00188452
RAILROAD MEDICARE
—
Enumeration date
02/09/2006
Last updated
07/31/2024
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