=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154828168
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN MINIER FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2018
-----------------------------------------------------
Last Update Date | 07/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6005 STATE BRIDGE RD APT 1215
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-6460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-977-5903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6005 STATE BRIDGE RD APT 1215
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-6460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN281218
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024176996
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | GAA-NP000705
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------