Provider Demographics
NPI:1326515768
Name:HEDDLESON, HOLLY HARVEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:HARVEY
Last Name:HEDDLESON
Suffix:
Gender:F
Credentials:FNP-C
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:704-316-5166
Mailing Address - Fax:704-316-5167
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY STE 280
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-316-5166
Practice Address - Fax:704-316-5167
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner