Healthcare Provider Details

I. General information

NPI: 1255374765
Provider Name (Legal Business Name): WILLIAM JEROME OXFORD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701B NC HIGHWAY 135
MAYODAN NC
27027-8487
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 336-635-8616
  • Fax: 336-635-6868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200300019
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: