Provider Demographics
NPI:1164012027
Name:FARIS, NATHAN DAKOTA (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAKOTA
Last Name:FARIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 TRYON RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7056
Mailing Address - Country:US
Mailing Address - Phone:193-782-3329
Mailing Address - Fax:
Practice Address - Street 1:6750 TRYON RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7056
Practice Address - Country:US
Practice Address - Phone:919-378-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant