Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 5013806 | NC |
NPI | 1053913483 |
---|---|
Provider Name | Jamie Avery |
First Address | Mount Olive, NC 28365-8217 |
Second Address | Jacksonville, NC 28540-5933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2020 |
Last Update Date | 21/12/2020 |