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MRS. NEICOLE DUTTON BLACK PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1033158548

Individual Registrant:
MRS. NEICOLE DUTTON BLACK PA-C
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1212 S WALNUT ST  FAIRMONT, NC 28340-1848 US
Tel: 910-628-6711  Fax: 910-628-5735

Contact information for business:
60 COMMERCE PLAZA CIR  PEMBROKE, NC 28372-7386 US
Tel: 910-521-2900  Fax: 910-775-9165

Registration Information:
NPI: 1033158548
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
SC1091
N363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
SC1091

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSE NUMBER1091SC01
8103286NC05




HEALTH CARE JOBS NC - Page 1

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