Healthcare Provider Details

I. General information

NPI: 1093675894
Provider Name (Legal Business Name): KRISHONA DRAYTON GILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 S MAIN ST
SALISBURY NC
28144-5412
US

IV. Provider business mailing address

714 S MAIN ST
SALISBURY NC
28144-5412
US

V. Phone/Fax

Practice location:
  • Phone: 866-495-3651
  • Fax:
Mailing address:
  • Phone: 866-495-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023493
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: