Healthcare Provider Details

I. General information

NPI: 1346711009
Provider Name (Legal Business Name): ERIN GILLIES BRISTOW NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W PARKVIEW DR
HENDERSON NC
27536-5923
US

IV. Provider business mailing address

100 W PARKVIEW DR
HENDERSON NC
27536-5923
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-3549
  • Fax: 252-438-2875
Mailing address:
  • Phone: 252-438-3549
  • Fax: 252-438-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: