Healthcare Provider Details

I. General information

NPI: 1770495350
Provider Name (Legal Business Name): KIARA CHARNELLE FRIDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W LIBERTY ST
SALISBURY NC
28144-4332
US

IV. Provider business mailing address

1235 EAST BLVD STE E
CHARLOTTE NC
28203-5876
US

V. Phone/Fax

Practice location:
  • Phone: 704-215-3990
  • Fax:
Mailing address:
  • Phone: 757-798-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025524
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: