Healthcare Provider Details

I. General information

NPI: 1235668419
Provider Name (Legal Business Name): NICOLE THOMPSON ANDERSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE LEE ANDERSON

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N FAYETTEVILLE ST STE 102
ASHEBORO NC
27203-4671
US

IV. Provider business mailing address

610 N FAYETTEVILLE ST STE 102
ASHEBORO NC
27203-4671
US

V. Phone/Fax

Practice location:
  • Phone: 743-224-7137
  • Fax: 336-290-5084
Mailing address:
  • Phone: 743-224-7137
  • Fax: 336-290-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5009635
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: