Healthcare Provider Details

I. General information

NPI: 1811421381
Provider Name (Legal Business Name): VICTORIA INGRAM WINDLEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W MOREHEAD ST FL 5
CHARLOTTE NC
28208-5576
US

IV. Provider business mailing address

44 WENDY CT
KERNERSVILLE NC
27284-9095
US

V. Phone/Fax

Practice location:
  • Phone: 844-943-2514
  • Fax: 844-705-0129
Mailing address:
  • Phone: 276-340-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5009439
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009439
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: