Provider Demographics
NPI:1487896247
Name:SHOE, PATTI JOYNER (FNP)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:JOYNER
Last Name:SHOE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 N 2ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3317
Mailing Address - Country:US
Mailing Address - Phone:704-982-0648
Mailing Address - Fax:704-982-0649
Practice Address - Street 1:923 N 2ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3317
Practice Address - Country:US
Practice Address - Phone:704-982-0648
Practice Address - Fax:704-982-0649
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC159XWOtherBCBS
NC7005598Medicaid
NC7005598Medicaid