Healthcare Provider Details

I. General information

NPI: 1073165148
Provider Name (Legal Business Name): CHRYSTAL DANNETTE GUNN GAMMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 CROUSE LN
BURLINGTON NC
27215-8833
US

IV. Provider business mailing address

PO BOX 45
SEDALIA NC
27342-0045
US

V. Phone/Fax

Practice location:
  • Phone: 366-266-0518
  • Fax:
Mailing address:
  • Phone: 434-429-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012088
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number5012088
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: