Provider Demographics
NPI:1871659441
Name:FAULKNER, JOHN HUME (PA-C, MPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HUME
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:PA-C, MPH
Other - Prefix:
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Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:114 MARKET ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NC
Practice Address - Zip Code:27823-1423
Practice Address - Country:US
Practice Address - Phone:252-445-2332
Practice Address - Fax:252-445-2983
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100881363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP48267Medicare UPIN
NCNCA637C058Medicare PIN