Healthcare Provider Details

I. General information

NPI: 1194324756
Provider Name (Legal Business Name): RAEGAN MCNEIL CHURCH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RAEGAN MCNEIL

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8439 VALLEY BLVD
BLOWING ROCK NC
28605-8957
US

IV. Provider business mailing address

310 HOSPITAL AVE
JEFFERSON NC
28640
US

V. Phone/Fax

Practice location:
  • Phone: 828-295-3116
  • Fax:
Mailing address:
  • Phone: 336-846-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013710
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: