Healthcare Provider Details

I. General information

NPI: 1194657775
Provider Name (Legal Business Name): THUDGELYNN NEILLY-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LONG SHOALS RD
ARDEN NC
28704-5544
US

IV. Provider business mailing address

4 LONG SHOALS RD PMB B744
ARDEN NC
28704-5544
US

V. Phone/Fax

Practice location:
  • Phone: 954-245-8863
  • Fax:
Mailing address:
  • Phone: 954-245-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNEIL-1EIZ6
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: