JUSTIN WAYNE BORDEAUX (NPI# 1366780033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366780033 |
| Entity Type | Individual |
| Full Name | JUSTIN WAYNE BORDEAUX |
| Credential | PA |
| Practice Address |
700 Us 1 Hwy Ste 100 Youngsville NC 27596-7873 |
| Mailing Address |
3762 Durham Rd A Roxboro NC 27573-2741 |
| Practice Telephone | 9195622340 |
| Practice Fax Number | 9195622315 |
| Mailing Telephone | (336) 330-0400 |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2017-09-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
0010-04057 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
700 US 1 HWY STE 100 |
| City | YOUNGSVILLE |
| State | NC |
| Zip Code | 27596-7873 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750323960 | Matthew Mullen | Specialist | 700 Us 1 Hwy Ste 100, Youngsville, NC 27596 | 2006-06-12 |
| 1154834687 | Dlp Person Urgent Care LLC | Durable Medical Equipment & Medical Supplies | 700 Us 1 Hwy Ste 100, Youngsville, NC 27596-7873 | 2017-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144879313 | Harp Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 12339 Wake Union Church Rd Ste 108, Wake Forest, NC 27596 | 2019-09-10 |
| 1326560806 | Nirali Patel | Pharmacist | 1190 Us Hwy 1n, Youngsville, NC 27596 | 2017-07-17 |
| 1790109577 | Riphen Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 203 Blue Heron Drive, Youngsville, NC 27596 | 2014-02-13 |
| 1831524768 | Janice D Clark, Dds, Pa | Dentist | 680 Us Hwy 1 N, Suite 500, Youngsville, NC 27596 | 2013-09-11 |
| 1720372733 | Sherri Culbertson | Pharmacist | 1190 Us Hwy 1 North, Youngsville, NC 27596 | 2011-06-07 |
| 1326368390 | Trg Health Care Systems LLC | Social Worker | 112 Wheaton Ave, Suite B, Youngsville, NC 27596 | 2010-06-01 |
| 1932250065 | Catherine Grace Busam | Counselor | 90 Wheaton Dr, Youngsville, NC 27596 | 2007-01-16 |
| 1316022700 | Emmett Smoak Ackermon Jr. | Dentist | 66 Wheaton Ave, Youngsville, NC 27596 | 2006-10-26 |
| 1992074314 | Trg Health Care Systems LLC | Community/Behavioral Health | 112 Wheaton Ave, Suite B, Youngsville, NC 27596 | 2011-12-14 |
| 1922044668 | Grant William Jenkins | Internal Medicine | 127 East Main Street, Youngsville, NC 27596 | 2006-06-21 |
| Find all providers in zip 27596 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902403884 | Billy Scott II | Physician Assistant | 3000 Rogers Rd Ste 100, Wake Forest, NC 27587-5745 | 2020-10-05 |
| 1982213765 | Michaela Lynne Mcbride | Physician Assistant | 9541 Kings Parade Blvd Unit 107, Charlotte, NC 28273-5819 | 2020-07-28 |
| 1386260347 | Elizabeth Warrington Maiche | Physician Assistant | 113 Montgomery Dr, Saluda, NC 28773-7787 | 2020-06-24 |
| 1831715663 | John Wheary | Physician Assistant | 3233 Austin Ave, New Bern, NC 28562-7084 | 2020-06-17 |
| 1629692439 | Julie Anne Augustine | Physician Assistant | 718 S Green St, Winston Salem, NC 27101-5112 | 2020-06-08 |
| 1659995710 | Kristopher Neal Priddy | Physician Assistant | 405 Forest Hill Dr, Shelby, NC 28150-5520 | 2020-06-04 |
| 1710500558 | Christian Wright Fulenwider | Physician Assistant | 104 Linden St, Morganton, NC 28655-3788 | 2020-05-27 |
| 1366065500 | Lisa Lynn Carder | Physician Assistant | 904 Foxcroft Cir Apt D, Shelby, NC 28152-6868 | 2020-05-22 |
| 1982234282 | Brandon Sorkin | Physician Assistant | 280 Executive Park Drive, Suite 100, Concord, NC 28025-2802 | 2020-01-25 |
| 1245860618 | Robert Maughan | Physician Assistant | 129 Bryce Creek Ln, Fayetteville, NC 28303-4981 | 2020-01-24 |
| Find all providers with the same taxonomy | ||||
| City | YOUNGSVILLE |
| Zip Code | 27596 |
Please comment or provide details below to improve the information on JUSTIN WAYNE BORDEAUX.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.