Healthcare Provider Details

I. General information

NPI: 1023741774
Provider Name (Legal Business Name): ARIANNA NICOLE VARNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

IV. Provider business mailing address

3645 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-8475
  • Fax:
Mailing address:
  • Phone: 910-339-8475
  • Fax: 910-339-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12411
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: