Healthcare Provider Details

I. General information

NPI: 1629587167
Provider Name (Legal Business Name): HEIDI DAVIES CHAPPELL AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 COURT DR STE 200
GASTONIA NC
28054-2178
US

IV. Provider business mailing address

2555 COURT DR STE 200
GASTONIA NC
28054-2178
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax:
Mailing address:
  • Phone: 704-834-3540
  • Fax: 704-834-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number192756
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: