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NPI Code Detail

MEDICARE: MRS. CARLY ANNE PEELER REGAN NP-C

MEDICARE: MRS. CARLY ANNE PEELER REGAN NP-C
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
1363LA2200XAdult Health Nurse Practitioner5005579NC
2363L00000XNurse Practitioner5005579NC

General Provider Information

NPI Number : 1104192533
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARLY ANNE PEELER REGAN NP-C
Provider Business Mailing Address
First Line : PO BOX 751803
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1803
Country : US
Telephone Number : 336-718-1680
Fax Number : 336-718-1681
Provider Business Practice Location Address
First Line : 6915 VILLAGE MEDICAL CIR
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8002
Country : US
Telephone Number : 336-718-1680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2012
Last Update Date : 03/11/2022

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