Healthcare Provider Details

I. General information

NPI: 1346119914
Provider Name (Legal Business Name): THEA LEANN PATTERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E CHURCH ST STE B
CHERRYVILLE NC
28021-2968
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-5227
  • Fax: 704-435-5233
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 Number5023380
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: