Healthcare Provider Details

I. General information

NPI: 1831704337
Provider Name (Legal Business Name): CHRISTAL PARKER CUDD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SPRUCE ST
BELMONT NC
28012-3370
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-825-5333
  • Fax: 704-825-1751
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013521
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: