MEDICARE: MILICARE PSYCHIATRY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1871484790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILICARE PSYCHIATRY, PLLC

Provider Business Mailing Address
First Line	:	145 RIVERSIDE DR
Second Line	:
City	:	RUTHERFORDTON
State	:	NC
Zip	:	28139-8162
Country	:	US
Telephone Number	:	337-842-4703
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 CHARLOTTE RD
Second Line	:
City	:	RUTHERFORDTON
State	:	NC
Zip	:	28139-2914
Country	:	US
Telephone Number	:	828-436-0228
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC MENTAL HEALTH NURSE PRA
Name	:	LARREN TEZENO
Credential	:	PMHNP
Telephone Number	:	828-436-0228

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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