Healthcare Provider Details

I. General information

NPI: 1396939443
Provider Name (Legal Business Name): MICHELE TIDWELL COLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MEDICAL PARK DR
JEFFERSON NC
28640-9560
US

IV. Provider business mailing address

2903 BROADSTONE RD
BANNER ELK NC
28604-9046
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-7161
  • Fax: 336-835-4761
Mailing address:
  • Phone: 828-493-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019172
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019172
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: