Healthcare Provider Details

I. General information

NPI: 1548014301
Provider Name (Legal Business Name): LAURA WILSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2874 NC HWY 127 SOUTH
HICKORY NC
28602-9131
US

IV. Provider business mailing address

2874 NC HWY 127 SOUTH
HICKORY NC
28602-9131
US

V. Phone/Fax

Practice location:
  • Phone: 828-294-4100
  • Fax: 828-294-4112
Mailing address:
  • Phone: 828-294-4100
  • Fax: 828-294-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019900
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: