Provider Demographics
NPI:1548392699
Name:FOXWORTH, NICOLE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 CAROLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742
Mailing Address - Country:US
Mailing Address - Phone:828-691-1460
Mailing Address - Fax:
Practice Address - Street 1:CON MET CANTON ONSITE HEALTH CLINIC
Practice Address - Street 2:171 GREAT OAK DRIVE
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716
Practice Address - Country:US
Practice Address - Phone:828-454-6055
Practice Address - Fax:828-696-2350
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant