Healthcare Provider Details

I. General information

NPI: 1912320938
Provider Name (Legal Business Name): HEIDI KATHERINE STODDARD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 JETTON RD STE 203
CORNELIUS NC
28031-4405
US

IV. Provider business mailing address

17901 JOHN CONNOR RD
CORNELIUS NC
28031-7662
US

V. Phone/Fax

Practice location:
  • Phone: 704-985-5223
  • Fax: 704-519-2620
Mailing address:
  • Phone: 704-906-1315
  • Fax: 704-519-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5009431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: