Healthcare Provider Details

I. General information

NPI: 1073359345
Provider Name (Legal Business Name): MEGAN HENTSCHEL CRISP FNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 SPRINGS RD NE
HICKORY NC
28601-3067
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 828-256-9853
  • Fax:
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06242151
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020420
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: