Healthcare Provider Details

I. General information

NPI: 1023983038
Provider Name (Legal Business Name): REX BOYSON PATULIN OLPOC FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 REGIONAL DR STE D
PINEHURST NC
28374-9868
US

IV. Provider business mailing address

502 HIDDEN TREASURE DR
DURHAM NC
27712-1476
US

V. Phone/Fax

Practice location:
  • Phone: 910-221-7195
  • Fax:
Mailing address:
  • Phone: 769-243-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: