Provider Demographics
NPI:1619783651
Name:FARRELL, MICHAELA ELIZABETH
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ELIZABETH
Last Name:FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PATTERSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3351
Mailing Address - Country:US
Mailing Address - Phone:315-224-6814
Mailing Address - Fax:
Practice Address - Street 1:319 SPRINGWOOD DR NE
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-8710
Practice Address - Country:US
Practice Address - Phone:828-879-8419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily