MEDICARE: MRS. CHRISTY HALL PARK MSN, ACNP-BC, 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
1	363L00000X	Nurse Practitioner	5004796	NC

General Provider Information

NPI Number	:	1528373545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTY HALL PARK MSN, ACNP-BC, NP-C

Provider Business Mailing Address
First Line	:	5900 SIX FORKS RD
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27609-3838
Country	:	US
Telephone Number	:	919-876-4327
Fax Number	:	919-876-6800

Provider Business Practice Location Address
First Line	:	5900 SIX FORKS RD
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27609-3838
Country	:	US
Telephone Number	:	919-876-4327
Fax Number	:	919-876-6800

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	04/10/2025

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