Healthcare Provider Details

I. General information

NPI: 1659295780
Provider Name (Legal Business Name): MIA CREEKMORE MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 NC 24 UNIT 87
CAMERON NC
28326-7671
US

IV. Provider business mailing address

148 MONTEBURG RD
FORT BRAGG NC
28307-1720
US

V. Phone/Fax

Practice location:
  • Phone: 919-373-3636
  • Fax:
Mailing address:
  • Phone: 727-638-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5025173
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: