Provider Demographics
NPI:1639541469
Name:GRAGG, HEATHER TEANNE (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:TEANNE
Last Name:GRAGG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 COLLETTSVILLE RD
Mailing Address - Street 2:POB 9
Mailing Address - City:COLLETTSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28611-9000
Mailing Address - Country:US
Mailing Address - Phone:828-754-6850
Mailing Address - Fax:828-757-3214
Practice Address - Street 1:1345 NC HIGHWAY 268
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9027
Practice Address - Country:US
Practice Address - Phone:828-754-6850
Practice Address - Fax:828-757-3214
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily