Provider Demographics
NPI:1942931209
Name:GREGSON, MARK WAYNE (FNP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:WAYNE
Last Name:GREGSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1913
Practice Address - Country:US
Practice Address - Phone:336-548-9618
Practice Address - Fax:336-584-4877
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC271678163W00000X
NC5016397363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner