Provider Demographics
NPI:1396229969
Name:PARTIN, MISTY N (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:N
Last Name:PARTIN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 COURT DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2180
Mailing Address - Country:US
Mailing Address - Phone:704-864-5550
Mailing Address - Fax:704-864-5550
Practice Address - Street 1:2555 COURT DR STE 400
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2180
Practice Address - Country:US
Practice Address - Phone:704-864-5550
Practice Address - Fax:704-864-5550
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010910363L00000X, 363LA2200X, 363LG0600X
NC224494363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5010910OtherNCBON