Provider Demographics
NPI:1669800843
Name:FOX, PETER RAYBURN (APRN)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:RAYBURN
Last Name:FOX
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:NH
Mailing Address - Zip Code:03457-5126
Mailing Address - Country:US
Mailing Address - Phone:603-313-3980
Mailing Address - Fax:
Practice Address - Street 1:10430 PARK RD STE 100A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8541
Practice Address - Country:US
Practice Address - Phone:704-259-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18552363LA2100X
NC5008614363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care