Healthcare Provider Details

I. General information

NPI: 1447867148
Provider Name (Legal Business Name): MRS. CHERYL HOLLAND SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2020
Last Update Date: 08/02/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 VILLAGE DR STE 201
FAYETTEVILLE NC
28304-3979
US

IV. Provider business mailing address

11522 NC HIGHWAY 210 S
ROSEBORO NC
28382-8858
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5700
  • Fax: 910-486-5950
Mailing address:
  • Phone: 910-229-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number232925
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013976
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013976
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: