Provider Demographics
NPI:1649928698
Name:CUNNINGHAM, NICHOLAS (PMHNP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SAM NEWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7593
Mailing Address - Country:US
Mailing Address - Phone:704-321-4940
Mailing Address - Fax:
Practice Address - Street 1:10341 ASHLEY FARM DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4581
Practice Address - Country:US
Practice Address - Phone:704-244-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCUNN-H1829363LP0808X
NC5016175363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health