Provider Demographics
NPI:1922710656
Name:COATS, DUSTIN BRANDON (FNP-C)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:BRANDON
Last Name:COATS
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 1:3031 NEW BERN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2989
Mailing Address - Country:US
Mailing Address - Phone:919-459-8409
Mailing Address - Fax:919-231-3912
Practice Address - Street 1:3031 NEW BERN AVE STE 306
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2989
Practice Address - Country:US
Practice Address - Phone:919-459-8409
Practice Address - Fax:919-231-3912
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily