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General NPI Number Information
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NPI Number | 1992254213
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Entity Type | Organization
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Legal Business Name | CAROLINAS HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 4525 CAMERON VALLEY PKWY SUITE 3100
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City | CHARLOTTE
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State | NC
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Zip | 28211-4369
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Country | US
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Telephone | 704-302-8310
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 CORTON DR APARTMENT L
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City | CHARLOTTE
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State | NC
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Zip | 28203-6090
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Country | US
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Telephone | 704-923-2028
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. JESSICA R STOVER
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Credential | AGNP-C
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Telephone | 704-923-2028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 5008798
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License Number State | NC
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