Healthcare Provider Details

I. General information

NPI: 1992201164
Provider Name (Legal Business Name): CHANTEL LISETTE DAWKINS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 10/26/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 JAKE ALEXANDER BLVD W STE 303
SALISBURY NC
28147-1177
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-797-2442
  • Fax: 704-797-2443
Mailing address:
  • Phone: 704-210-5061
  • Fax: 704-210-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5010423
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010423
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: