Provider Demographics
NPI:1285212985
Name:VERNON, NICHOLAS (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:VERNON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 CLINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:RONDA
Mailing Address - State:NC
Mailing Address - Zip Code:28670-8708
Mailing Address - Country:US
Mailing Address - Phone:336-984-3003
Mailing Address - Fax:
Practice Address - Street 1:3369 CLINGMAN RD
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670-8708
Practice Address - Country:US
Practice Address - Phone:336-984-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine