Healthcare Provider Details

I. General information

NPI: 1942710009
Provider Name (Legal Business Name): MIRANDA RENEE GAINEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 CREEKSTONE DR STE 105
DURHAM NC
27703-8242
US

IV. Provider business mailing address

4825 CREEKSTONE DR STE 105
DURHAM NC
27703-8242
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-3232
  • Fax: 919-941-9173
Mailing address:
  • Phone: 919-286-3232
  • Fax: 919-941-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014345
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number5014345
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: