Individual
KRYSTIN BROOKE HEPBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
125 QUEENS RD STE 400, CHARLOTTE, NC 28204-3215
(980) 302-6400
(980) 302-6405
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
258915
NC
363L00000X
Nurse Practitioner
Primary
5012249
NC
363LA2200X
Adult Health Nurse Practitioner
258915
NC
363LG0600X
Gerontology Nurse Practitioner
258915
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437708310
—
NC
Enumeration date
09/04/2019
Last updated
07/07/2026
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