Healthcare Provider Details

I. General information

NPI: 1780293266
Provider Name (Legal Business Name): CHAD EDWARD ALLEN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N FAYETTEVILLE ST STE A
ASHEBORO NC
27203-5573
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-3248
  • Fax: 336-625-6629
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013378
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5013378
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5013378
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5013378
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: