Provider Demographics
NPI:1225224728
Name:EASTER, MOLLY KAY (NP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:KAY
Last Name:EASTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4522
Mailing Address - Fax:336-789-3025
Practice Address - Street 1:510 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030
Practice Address - Country:US
Practice Address - Phone:336-786-4522
Practice Address - Fax:336-789-3025
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005003119363LF0000X
NC5003119363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02774OtherSTATE HEALTH BCBS
NC02774OtherSTATE HEALTH BCBS