Organization
KIDS CARE PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBRA J TETREAULT M.D. (PRESIDENT)
(919) 938-3749
Entity
Organization
Contact information
Practice address
101 KELLIE DR, SMITHFIELD, NC 27577-9443
(919) 938-3749
(919) 938-3795
Mailing address
101 KELLIE DR, SMITHFIELD, NC 27577-9443
(919) 938-3749
(919) 938-3795
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
147337
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902042
—
NC
Enumeration date
05/03/2006
Last updated
09/23/2024
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