Healthcare Provider Details

I. General information

NPI: 1053849133
Provider Name (Legal Business Name): NICOLE DANIELLE BURNS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DARRINGTON DR STE 100
CARY NC
27513-8133
US

IV. Provider business mailing address

PO BOX 604337
CHARLOTTE NC
28260-4337
US

V. Phone/Fax

Practice location:
  • Phone: 919-882-6100
  • Fax: 919-877-4797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16460
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: