Individual
MRS. CRISTIE WELLS FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, RD, LDN
Contact information
Practice address
10130 PERIMETER PKWY, STE 200, CHARLOTTE, NC 28216-2447
(888) 849-7379
(855) 857-7333
Mailing address
10130 PERIMETER PKWY, STE 200, CHARLOTTE, NC 28216-2447
(888) 849-7379
(855) 857-7333
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
915208
NC
133V00000X
Registered Dietitian
L002256
NC
363A00000X
Physician Assistant
Primary
0010-1457
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17998
BCBS NC
NC
05
—
8101417
—
NC
Enumeration date
08/12/2008
Last updated
02/10/2017
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