Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 5012088 | NC |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 0024177827 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5012088 | NC |
NPI | 1073165148 |
---|---|
Provider Name | Chrystal Gammon |
First Address | Sedalia, NC 27342-0045 |
Second Address | Mount Airy, NC 27030-5026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2019 |
Last Update Date | 10/10/2020 |