Healthcare Provider Details

I. General information

NPI: 1881110559
Provider Name (Legal Business Name): MICHELLE LEIGH WOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 BALLANTYNE PARKWAY STE 300
CHARLOTTE NC
28277
US

IV. Provider business mailing address

7810 BALLANTYNE COMMONS PKWY STE 300
CHARLOTTE NC
28277-3416
US

V. Phone/Fax

Practice location:
  • Phone: 704-342-0252
  • Fax: 980-533-7801
Mailing address:
  • Phone: 704-342-0252
  • Fax: 980-533-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5011331
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5011331
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21168
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: