=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164287223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER N HUNT NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2024
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 CABARRUS AVE E STE 200
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-3781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-743-2247
-----------------------------------------------------
Fax | 855-857-7333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7181 JOHNS POINT CT
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27298-8412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-328-6805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 311072
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5021015
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------