Community Practitioner Program
Dashboard
date-266
2021-08-24
Professional
Physician Asstistant
PracticeName
Fayetteville Practice
MonthYearStartedPracticingCurrentSite
2020-01-09
PracticeCity
Fayetteville
Practice
28910
OfficePhone
555-555-5555
HomeAddress
45677 Able dr
HomeState
nc
HomeCounty
fayetteville
NCMedicalBoardLicenseNumber
5567890
checkbox-589
No
checkbox-924
Yes
textarea-514
I received 1 grant during my schooling through my scholarship applications. I additionally received a grant for
COVID relief during my schooling. I am not currently receving state or federal education grants at this time.
Total loans (excluding undergraduate loans): $80,000
PercentageofPractice
1
practicebusinessmanager
May Baleen
EmailAddress
maybaleen@gmail.com
practitionerssalary
98,000
Signature
Dawn Mosty
file-233
a60a7ac26125643b65700ea47e5f1969
Sequence Number
your-name
Dawn Mosty
Type
Primary Care
MonthYearStartedPracticing
2020-02-11
PracticeAddress
55699 Fayetteville dr
PracticeState
nc
PracticeCounty
fayetteville
HomePhone
555-555-5555
HomeCity
Fayetteville
HomeZip
28910
your-email
fayettveille@gmail.com
checkbox-900
No
PracticesManagementStructureandPrincipalOwners
Practice management structure: Regional Director, Regional Operation Manager, and Medical Director
Principal owner: Vidant Health Systems
Listallprovidersandtheirprofessionalstatus
Dr. TonasdLitte, MD
Dr. Masdfn Hsdfing, MD
Amanda Cdfson, AGNP-C
Tracy Sdfsd, ANP
checkbox-864
Yes,Yes,Yes,Yes,Yes,Yes,Yes,Yes,No,No,Yes,No,No,No,Yes,No
NumberofPatients
1
ContactNumber
555-555-5555
languagesspoken
French, Spanish
Loanamount
20,000
date-533
2021-08-24
Entry ID
2021/08/24 at 1:26 pm