Individual
STEPHANIE TICKERHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
280 BROAD ST, SUITE A, KERNERSVILLE, NC 27284-2796
(336) 277-6430
(336) 277-6448
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 277-6430
(336) 277-6448
Taxonomy
Speciality
Code
Description
License number
State
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
201811
NC
363L00000X
Nurse Practitioner
Primary
201811
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7003723
—
NC
Enumeration date
02/28/2008
Last updated
10/28/2020
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