Healthcare Provider Details

I. General information

NPI: 1487120614
Provider Name (Legal Business Name): DALLAS WELBORN HURLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S FAYETTEVILLE ST STE B
ASHEBORO NC
27205
US

IV. Provider business mailing address

2222 S FAYETTEVILLE ST STE B
ASHEBORO NC
27205-7368
US

V. Phone/Fax

Practice location:
  • Phone: 336-318-6200
  • Fax: 336-636-7686
Mailing address:
  • Phone: 336-318-6200
  • Fax: 336-636-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011092
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: