Healthcare Provider Details

I. General information

NPI: 1972432979
Provider Name (Legal Business Name): MR. DYRON PRATT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MRS. OCTAVYA PRATT

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 BOSTON RD
ROXBORO NC
27574-7573
US

IV. Provider business mailing address

6333 BOSTON RD
ROXBORO NC
27574-7573
US

V. Phone/Fax

Practice location:
  • Phone: 919-358-3216
  • Fax:
Mailing address:
  • Phone: 919-358-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number23331900
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: