Provider Demographics
NPI:1962153098
Name:HEDRICK, CHARLISA CABLE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHARLISA
Middle Name:CABLE
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL RD.
Mailing Address - Street 2:CALLER BOX C - 268
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:828-497-9254
Practice Address - Street 1:1 HOSPITAL RD.
Practice Address - Street 2:CALLER BOX C - 268
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-2871
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:828-497-9254
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHEDR-L9OLK363LF0000X
NC5015596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily