Provider Demographics
NPI:1407560550
Name:PROCTOR, AUDREY DAWN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:DAWN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-9711
Mailing Address - Country:US
Mailing Address - Phone:336-309-0205
Mailing Address - Fax:
Practice Address - Street 1:4531 ARNOLD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-9711
Practice Address - Country:US
Practice Address - Phone:336-309-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017474363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner