Healthcare Provider Details

I. General information

NPI: 1952187890
Provider Name (Legal Business Name): NICOLAS CLINE WEST FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 WESTCHESTER DR STE 101
HIGH POINT NC
27262-7369
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2105
  • Fax:
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: