Provider Demographics
NPI:1043756794
Name:DAGENHART, BILLIE JO (NP-C)
Entity Type:Individual
Prefix:
First Name:BILLIE JO
Middle Name:
Last Name:DAGENHART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2138
Mailing Address - Country:US
Mailing Address - Phone:704-671-5400
Mailing Address - Fax:704-671-5420
Practice Address - Street 1:640 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE 200
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2138
Practice Address - Country:US
Practice Address - Phone:704-671-5400
Practice Address - Fax:704-671-5420
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC179261363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner