Provider Demographics
NPI:1306592530
Name:LEDOUX, MARY JOY-ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOY-ANN
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOY-ANN
Other - Last Name:QUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:905 THUNDER RD STE 140
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7672
Mailing Address - Country:US
Mailing Address - Phone:252-334-0320
Mailing Address - Fax:
Practice Address - Street 1:905 THUNDER RD STE 140
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7672
Practice Address - Country:US
Practice Address - Phone:252-334-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016853363L00000X
VA0024183834363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner