Healthcare Provider Details

I. General information

NPI: 1265399588
Provider Name (Legal Business Name): PERRY WINFORD FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 WESTERN BLVD STE 122
JACKSONVILLE NC
28546-7637
US

IV. Provider business mailing address

461 WESTERN BLVD
JACKSONVILLE NC
28546-7636
US

V. Phone/Fax

Practice location:
  • Phone: 910-333-0283
  • Fax: 910-333-0513
Mailing address:
  • Phone: 910-333-0283
  • Fax: 910-333-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024598
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: