Healthcare Provider Details

I. General information

NPI: 1457776874
Provider Name (Legal Business Name): KRISTINA ALISA TAYLOR-LEWIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17078 NAT BYNUM LN UNIT 3
CORNELIUS NC
28031-0507
US

IV. Provider business mailing address

PO BOX 601843
CHARLOTTE NC
28260-1843
US

V. Phone/Fax

Practice location:
  • Phone: 704-324-3975
  • Fax: 704-324-3974
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number809206
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010021
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: