Provider Demographics
NPI:1487120614
Name:HURLEY, DALLAS WELBORN (FNP-C)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:WELBORN
Last Name:HURLEY
Suffix:
Gender:F
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 1:2222 S FAYETTEVILLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-7368
Mailing Address - Country:US
Mailing Address - Phone:336-318-6200
Mailing Address - Fax:336-636-7686
Practice Address - Street 1:2222 S FAYETTEVILLE ST STE B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205
Practice Address - Country:US
Practice Address - Phone:336-318-6200
Practice Address - Fax:336-636-7686
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily