Healthcare Provider Details

I. General information

NPI: 1508685777
Provider Name (Legal Business Name): CHRISTINA ODOM GILYARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 TODAYS WOMAN AVE
WINSTON SALEM NC
27105-5069
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-722-1818
  • Fax: 336-722-1826
Mailing address:
  • Phone: 336-722-1818
  • Fax: 336-722-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020983
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5020983
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: