Healthcare Provider Details

I. General information

NPI: 1841635893
Provider Name (Legal Business Name): JESSICA LYNN PLYLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

4160 APPLETON HOLLOW AVE NW
CONCORD NC
28027-4502
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-9000
  • Fax:
Mailing address:
  • Phone: 704-793-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number193054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: