Healthcare Provider Details

I. General information

NPI: 1336637677
Provider Name (Legal Business Name): MICHELLE VERNON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LOUISIANA AVE
ASHEVILLE NC
28806-3421
US

IV. Provider business mailing address

105 LOUISIANA AVE
ASHEVILLE NC
28806-3421
US

V. Phone/Fax

Practice location:
  • Phone: 608-588-5669
  • Fax: 608-588-5669
Mailing address:
  • Phone: 608-588-5669
  • Fax: 608-588-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024432
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number299684
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: