MEDICARE: LAURA GREGORY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	273884	NC
2	363LF0000X	Family Nurse Practitioner	5013484	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F06202752	OTHER		AMERICAN ACADEMY OF NURSE PRACTITIONERS

General Provider Information

NPI Number	:	1033722970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GREGORY FNP

Provider Business Mailing Address
First Line	:	4115 THE PLZ
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1356
Country	:	US
Telephone Number	:	704-532-4567
Fax Number	:	704-532-4580

Provider Business Practice Location Address
First Line	:	4115 THE PLZ
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1356
Country	:	US
Telephone Number	:	704-532-4567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2020
Last Update Date	:	10/01/2025

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