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Individual

NICOLE RENEE ENNIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
300 KELLY RD, PINEHURST, NC 28374-8099
(910) 420-0226
Mailing address
100 FLYFOOT DR, STEPHENSON, VA 22656-1955
(304) 670-6877

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024179001
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5017739
NC

Other

Enumeration date
07/27/2019
Last updated
07/28/2023
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