=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437008471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN PARK MEDICAL AESTHETICS & WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2026
-----------------------------------------------------
Last Update Date | 01/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 390 WALMART PLAZA SUITE D
-----------------------------------------------------
City | SYLVA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-820-2210
-----------------------------------------------------
Fax | 971-203-0914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 WALMART PLAZA SUITE D
-----------------------------------------------------
City | SYLVA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-820-2210
-----------------------------------------------------
Fax | 971-203-0914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | LAURA MILLER
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 828-820-2210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------