Healthcare Provider Details

I. General information

NPI: 1356250559
Provider Name (Legal Business Name): CHELSEY MONET EMMA GRAVELY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S SUTHERLAND AVE
MONROE NC
28112-5060
US

IV. Provider business mailing address

763 LOCK HAVEN DR NW
CONCORD NC
28027-9170
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-9267
  • Fax:
Mailing address:
  • Phone: 276-806-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: