MRS. CRISTIE WELLS FAIRCLOTH


Address: 10130 Perimeter Pkwy, Ste 200, Charlotte, NC 28216-2447
Phone: 8888497379

MRS. CRISTIE WELLS FAIRCLOTH (NPI# 1487800314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1487800314
Entity Type Individual
Full Name MRS. CRISTIE WELLS FAIRCLOTH
Other Name MISS CRISTIE MARIE WELLS
Credential PA-C, RD, LDN
Practice Address 10130 Perimeter Pkwy
Ste 200
Charlotte
NC 28216-2447
Practice Telephone 8888497379
Practice Fax Number 8558577333
Mailing Telephone 8888497379
Mailing Fax Number 8558577333
Enumeration Date 2008-08-12
Last Update Date 2017-02-10
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 133V00000X Dietitian, Registered 915208 NC Dietary & Nutritional Service Providers
N 133V00000X Dietitian, Registered L002256 NC Dietary & Nutritional Service Providers
Y 363A00000X Physician Assistant 0010-1457 NC Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
NC BCBS NC 17998 01
NC 8101417 05

Office Location

Street Address 10130 PERIMETER PKWY
STE 200
City CHARLOTTE
State NC
Zip Code 28216-2447

Providers in the same location

NPI Name Taxonomy Address Enumeration
1629025655 William Simpson Sampson Iv Psychologist 10130 Perimeter Pkwy, Ste 200, Charlotte, NC 28216-2447 2006-05-27
1467824672 Dana Aubrey Preston Physician Assistant 10130 Perimeter Pkwy, Suite 200, Charlotte, NC 28216-2447 2015-10-27
1225436264 Truly Therapeutic Rehab Solutions, Pllc Clinic/Center 10130 Perimeter Pkwy, Suite 200, Charlotte, NC 28216-2447 2014-12-08
1174923163 Carly Davison Social Worker 10130 Perimeter Pkwy, Ste 200, Charlotte, NC 28216-2447 2014-08-27
1083022321 Valer Consulting Counselor 10130 Perimeter Pkwy, Suite 200, Charlotte, NC 28216-2447 2014-07-30
1326454752 Lorrie Miller Counselor 10130 Perimeter Pkwy, Suite 200, Charlotte, NC 28216-2447 2014-07-07
1346655891 Lisette Jenee-moore Deese Social Worker 10130 Perimeter Pkwy, Ste 200, Charlotte, NC 28216-2447 2014-06-24
1598186843 Scotillia N Mcphaul Occupational Therapist 10130 Perimeter Pkwy, Suite 200, Charlotte, NC 28216-2447 2014-01-03
1912338328 Onsite Care Pllc Psychologist 10130 Perimeter Pkwy, Suite 200, Charlotte, NC 28216-2447 2013-12-11
1730454729 Alexis Veronica Lake Social Worker 10130 Perimeter Pkwy, Ste 200, Charlotte, NC 28216-2447 2012-03-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1942837331 Transit Consortium of South Carolina, LLC Non-emergency Medical Transport (VAN) 5025 Roundstone Way, Suite 103, Charlotte, NC 28216 2020-03-25
1811538796 Strengthening Families Within Communities LLC Community/Behavioral Health 4135 Bryan Furr Drive, Charlotte, NC 28216 2019-10-02
1841705159 Karen Sue Rhea Registered Nurse 4004 Nicole Eileen Lane, Charlotte, ND 28216 2017-12-08
1992225890 Be Free Counseling, Pllc Social Worker 7800 Bridle Court, Charlotte, NC 28216 2017-06-21
1013466416 Roha Solutions, Inc Community Based Residential Treatment Facility, Mental Illness 1529 Jennings St, Charlotte, NC 28216 2016-09-26
1336595826 North Carolina Neurodiagnostics, LLC Clinic/Center 10130 Perimeter Pwky, Ste. 200, Office 250, Charlotte, NC 28216 2016-05-13
1346600699 Elizabeth Ayodele Agiri Registered Nurse 9404 Perimeter Station Dr, Apt. 108, Charlotte, NC 28216 2016-02-29
1922479179 Prashant Patel Pharmacist 9820 Callibridge Court, Charlotte, NC 28216 2015-10-14
1205226685 Sarah Baker Social Worker 10506 Grobie Way Apt 104, Charlotte, NC 28216 2015-01-23
1578967089 The Moon Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 4548 Hyperion Court, Charlotte, NC 28216 2014-10-13
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1396351607 Michael James Blackwell Physician Assistant 501 Billingsley Rd Ste B, Charlotte, NC 28211-1009 2020-09-22
1598371320 Jonathan Byron Lively Physician Assistant 1000 Blythe Blvd Fl 3, Charlotte, NC 28203-5812 2020-09-17
1902415532 Jacqueline Ellen Leyrer Physician Assistant 2630 E 7th St Ste 200, Charlotte, NC 28204-4319 2020-07-29
1750908380 Whitney Debroy Physician Assistant 125 W Tremont Ave Unit 726, Charlotte, NC 28203-5551 2020-06-30
1972129302 Ashley Nicole Short Physician Assistant 1022 E Worthington Ave, Charlotte, NC 28203-5760 2020-06-22
1558985176 Courtney Claugus Physician Assistant 300 E Park Ave Unit 7, Charlotte, NC 28203-4774 2020-05-29
1467071738 Patrick James Quinn Physician Assistant 2036 Millerton Ave Apt 4311, Charlotte, NC 28208-5290 2020-04-15
1225660301 Sunil Ranchhod Ghodasara Physician Assistant 1001 Blythe Blvd Ste 403, Charlotte, NC 28203-5863 2020-02-06
1225668601 Emily Rebecca Markey Physician Assistant 355 W Mlk Blvd Apt 1112, Charlotte, NC 28202-0043 2020-01-24
1639719586 Abosede Elizabeth Adamson Physician Assistant 3101 Amesbury Hill Dr, Charlotte, NC 28269-8951 2020-01-08
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Competitor

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City CHARLOTTE
Zip Code 28216

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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