Healthcare Provider Details

I. General information

NPI: 1033189253
Provider Name (Legal Business Name): BETTY C MOREHEAD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N DEKALB ST
SHELBY NC
28150-3911
US

IV. Provider business mailing address

711 N DEKALB ST
SHELBY NC
28150-3911
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-1482
  • Fax: 704-482-0811
Mailing address:
  • Phone: 704-482-1482
  • Fax: 704-482-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200969
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200969
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: