Provider Demographics
NPI:1093378291
Name:BOSTIAN, CHARIS CRAIG (FNP)
Entity Type:Individual
Prefix:
First Name:CHARIS
Middle Name:CRAIG
Last Name:BOSTIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 JAKE ALEXANDER BLVD W STE 101A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1385
Practice Address - Country:US
Practice Address - Phone:704-637-5668
Practice Address - Fax:704-637-5605
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011682363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner