Provider Demographics
NPI:1851960173
Name:WILMOTH, MARY ANN (PMHNP - BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WILMOTH
Suffix:
Gender:
Credentials:PMHNP - BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 S CENTER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:THURMOND
Mailing Address - State:NC
Mailing Address - Zip Code:28683-9683
Mailing Address - Country:US
Mailing Address - Phone:336-528-5785
Mailing Address - Fax:
Practice Address - Street 1:499 S CENTER CHURCH RD
Practice Address - Street 2:
Practice Address - City:THURMOND
Practice Address - State:NC
Practice Address - Zip Code:28683-9683
Practice Address - Country:US
Practice Address - Phone:336-528-5785
Practice Address - Fax:336-222-6301
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014707363LP0808X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty