Provider Demographics
NPI:1730943663
Name:FANN, AUSTIN (FNP-C)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:FANN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 MCPHAIL RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28382-7066
Mailing Address - Country:US
Mailing Address - Phone:910-214-6792
Mailing Address - Fax:
Practice Address - Street 1:58 OLD ROBERTS RD # 102
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8047
Practice Address - Country:US
Practice Address - Phone:919-934-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily