Provider Demographics
NPI:1831381805
Name:NOBLE, REX ULYSSES (PA-C)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:ULYSSES
Last Name:NOBLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-719-7112
Mailing Address - Fax:336-786-3752
Practice Address - Street 1:314 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4491
Practice Address - Country:US
Practice Address - Phone:336-719-0011
Practice Address - Fax:336-719-0714
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-7990363AS0400X
FLPA9104281363AS0400X
NC0010-07990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831381805Medicaid
FL00007116OtherFLORIDA PHYSICIAN PRESCRIPTION LICENSE #
FL292935000Medicaid
FLAH599XMedicare PIN