Organization
HOMETOWN MED OF MOYOCK AND OBX PLLC
Active
Organization
HOMETOWN MED OF MOYOCK AND OBX PLLC
Active
Other names
Hometown Med Of Moyock and OBX PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN M WYNES NP (OWNER)
(252) 772-1110
Entity
Organization
Contact information
Practice address
109 CURRITUCK COMMERICAL DR STE A, MOYOCK, NC 27958-9068
(252) 772-1110
(252) 319-3678
Mailing address
109 CURRITUCK COMMERICAL DR STE A, MOYOCK, NC 27958-9068
(252) 772-1110
(252) 319-3678
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073000816
—
VA
05
—
1750021325
—
NC
Enumeration date
03/31/2022
Last updated
04/26/2023
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