Provider Demographics
NPI:1932708377
Name:RINGOOT, CELESTE BREANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:BREANNE
Last Name:RINGOOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:BREANNE
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:11200 GOVERNOR MANLY WAY STE 114
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7360
Practice Address - Country:US
Practice Address - Phone:919-570-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113323208D00000X
NC0010-10860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice