Provider Demographics
NPI:1770029035
Name:THRELKELD, MADISON FOX (NP-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:FOX
Last Name:THRELKELD
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 1:209 PARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-5205
Mailing Address - Country:US
Mailing Address - Phone:704-825-4750
Mailing Address - Fax:704-825-6985
Practice Address - Street 1:209 PARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-5205
Practice Address - Country:US
Practice Address - Phone:704-825-4750
Practice Address - Fax:704-825-6985
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily