Individual
MRS. JUSTINE KOERNER TYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1350 S KINGS DR, CHARLOTTE, NC 28207-2134
(704) 446-1422
(704) 446-1582
Mailing address
PO BOX 601372, CHARLOTTE, NC 28260-1372
(704) 446-1422
(704) 446-1582
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
160512
NC
363LP0200X
Pediatric Nurse Practitioner
5005317
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366724098
—
NC
05
—
1558308080
—
NC
05
—
NP2580
—
SC
Enumeration date
09/20/2011
Last updated
01/03/2014
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