Healthcare Provider Details

I. General information

NPI: 1841137270
Provider Name (Legal Business Name): DANIEL KODY WOOTEN BEAUDIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

437 AUTUMN MOON DR
ZEBULON NC
27597-4465
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-5756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number345357
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: