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General NPI Number Information
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NPI Number | 1356986079
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Entity Type | Individual
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Provider Name | JORDAN MILLER WINGATE MS, RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1900 3RD AVENUE LN SE
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City | HICKORY
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State | NC
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Zip | 28602-2959
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Country | US
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Telephone | 828-304-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 220 PINE MEADOWS CIR
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City | HICKORY
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State | NC
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Zip | 28601-8624
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Country | US
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Telephone | 336-328-5712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86072145
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License Number State | NC
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