Provider Demographics
NPI:1851860183
Name:FOSSETT, WILLIAM (FNP-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:FOSSETT
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 1:405 BUCCANEER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2722
Mailing Address - Country:US
Mailing Address - Phone:910-431-0655
Mailing Address - Fax:
Practice Address - Street 1:301 S CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5011
Practice Address - Country:US
Practice Address - Phone:910-259-5721
Practice Address - Fax:910-259-8002
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily