Healthcare Provider Details

I. General information

NPI: 1679547533
Provider Name (Legal Business Name): JEFFREY WAYNE HIVELY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 BOLICK LN STE 202
TAYLORSVILLE NC
28681-4362
US

IV. Provider business mailing address

174 BOLICK LN STE 202
TAYLORSVILLE NC
28681-4362
US

V. Phone/Fax

Practice location:
  • Phone: 828-732-5680
  • Fax: 828-732-5681
Mailing address:
  • Phone: 828-732-5680
  • Fax: 828-732-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101247969
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022-03128
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: