Individual
MR. TRISTAN MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1415 PHYSICIANS DR, WILMINGTON, NC 28401-7338
(910) 662-9500
(910) 662-9501
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5008581
NC
363LF0000X
Family Nurse Practitioner
260336
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912354739
—
NC
Enumeration date
05/23/2016
Last updated
05/27/2021
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