Provider Demographics
NPI:1558459412
Name:PABON, JOHN (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:PABON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43905
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-3905
Mailing Address - Country:US
Mailing Address - Phone:910-323-1322
Mailing Address - Fax:910-323-1510
Practice Address - Street 1:1756 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-323-1322
Practice Address - Fax:910-323-1510
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2592821Medicare ID - Type Unspecified