Healthcare Provider Details

I. General information

NPI: 1205761020
Provider Name (Legal Business Name): AVA JOY MYERS AGNP
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: AVA JOY TABANERA

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 NC HIGHWAY 49 N
MOUNT PLEASANT NC
28124-9663
US

IV. Provider business mailing address

9800 NC HIGHWAY 49 N
MOUNT PLEASANT NC
28124-9663
US

V. Phone/Fax

Practice location:
  • Phone: 910-303-5925
  • Fax:
Mailing address:
  • Phone: 910-303-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: