Provider Demographics
NPI:1861859589
Name:WEBSTER, DAKOTA (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAKOTA
Middle Name:
Last Name:WEBSTER
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 1:420 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2892
Mailing Address - Country:US
Mailing Address - Phone:252-752-4124
Mailing Address - Fax:252-752-0449
Practice Address - Street 1:204 EARNHART DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8400
Practice Address - Country:US
Practice Address - Phone:252-752-4124
Practice Address - Fax:252-752-0449
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06179363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical