Individual
MRS. NEICOLE DUTTON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2410 HOFFMEYER RD, FLORENCE, SC 29501-7311
(843) 882-6162
(843) 662-8183
Mailing address
60 COMMERCE PLAZA CIR, PEMBROKE, NC 28372-7386
(910) 521-2900
(910) 775-9165
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1091
SC
363AM0700X
Medical Physician Assistant
1091
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1091
STATE LICENSE NUMBER
SC
05
—
8103286
—
NC
Enumeration date
06/06/2006
Last updated
09/05/2019
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