Provider Demographics
NPI:1205964046
Name:RAYNOR, TAMELA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAMELA
Middle Name:MARIE
Last Name:RAYNOR
Suffix:
Gender:F
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 1:1743 SOUTHPOINT LN
Mailing Address - Street 2:
Mailing Address - City:BADIN LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28127-9141
Mailing Address - Country:US
Mailing Address - Phone:336-461-3614
Mailing Address - Fax:336-461-3614
Practice Address - Street 1:217 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-3201
Practice Address - Country:US
Practice Address - Phone:910-572-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101695363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical