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Individual
MIJEONG PARK
Active
Individual
MIJEONG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN306003
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135452367
PHCS/MULTIPLAN
NC
01
—
1579732
WELLPATH
NC
01
—
1710354907
HUMANA
NC
05
—
1710354907
—
NC
05
—
1710354907
—
TX
01
—
19EFK
BCBS OF NC
NC
01
—
298447
MEDCOST
NC
01
—
3455644
CIGNA/GREATWEST
NC
01
—
4632274
COVENTRY NATIONAL - COVENTRY PPO
NC
01
—
4948746
AETNA
NC
01
—
5707800
UNITED HEALTHCARE
NC
01
—
FH4002315
FIRST CAROLINA CARE
NC
Enumeration date
08/24/2015
Last updated
10/26/2025
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