Individual
JESSICA LANE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
128 MEDICAL PARK RD STE 200, MOORESVILLE, NC 28117-8579
(704) 696-2085
(704) 660-0194
Mailing address
PO BOX 1845, STATESVILLE, NC 28687-1845
(704) 873-4277
(704) 978-3549
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5015952
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
5015952
NC
Other
Enumeration date
03/08/2021
Last updated
11/12/2024
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