Provider Demographics
NPI:1235894189
Name:MCNALLY, CHARLES JOSEPH (NP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 FAIRGROVE CHURCH RD SE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9090
Mailing Address - Country:US
Mailing Address - Phone:282-670-5518
Mailing Address - Fax:
Practice Address - Street 1:929 15TH ST NE STE 100
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4162
Practice Address - Country:US
Practice Address - Phone:828-327-6026
Practice Address - Fax:828-537-1238
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015197363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5015197OtherNP