Provider Demographics
NPI:1043230121
Name:MOUL, JAMIE LYNN
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:MOUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 WINDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 RIVERS STREET
Practice Address - Street 2:HOLMES CONVOCATION CENTER
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0001
Practice Address - Country:US
Practice Address - Phone:828-262-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer