Healthcare Provider Details

I. General information

NPI: 1437086659
Provider Name (Legal Business Name): GRACE ALEXANDRA COLLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 SHORT RD APT 208
HICKORY NC
28602-8791
US

IV. Provider business mailing address

3061 SHORT RD APT 208
HICKORY NC
28602-8791
US

V. Phone/Fax

Practice location:
  • Phone: 828-310-6772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number333806
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: