Provider Demographics
NPI:1356595169
Name:FOHR, CHRISSY GAYLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISSY
Middle Name:GAYLE
Last Name:FOHR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:CHRISSY
Other - Middle Name:GAYLE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:378 WILLIAMSON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5917
Mailing Address - Country:US
Mailing Address - Phone:704-662-0009
Mailing Address - Fax:704-360-2335
Practice Address - Street 1:378 WILLIAMSON RD STE 204
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5917
Practice Address - Country:US
Practice Address - Phone:704-662-0009
Practice Address - Fax:704-360-2335
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC181443163W00000X
NC5004119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004274Medicaid