Provider Demographics
NPI:1386483717
Name:RAPHA WOUND CARE PLLC
Entity type:Organization
Organization Name:RAPHA WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMP
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:336-663-3822
Mailing Address - Street 1:935 E MOUNTAIN ST STE M
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3238
Mailing Address - Country:US
Mailing Address - Phone:336-663-3822
Mailing Address - Fax:
Practice Address - Street 1:935 E MOUNTAIN ST STE M
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3238
Practice Address - Country:US
Practice Address - Phone:336-663-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty