Healthcare Provider Details

I. General information

NPI: 1184343584
Provider Name (Legal Business Name): KANDICE DI-ANN SPEIGHT AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 10/11/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CABARRUS AVE E
CONCORD NC
28025-3699
US

IV. Provider business mailing address

1137 TRENTINI AVE
WAKE FOREST NC
27587-4307
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-7379
  • Fax:
Mailing address:
  • Phone: 252-363-4762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5016832
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5016832
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5016832
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: