Individual
JADEN MOORE MIETHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
167 MOORE RD STE 201, KING, NC 27021-8770
(336) 673-6470
(336) 673-6489
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5015274
NC
363LP0200X
Pediatric Nurse Practitioner
5015274
NC
Other
Enumeration date
11/01/2021
Last updated
03/02/2022
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