Provider Demographics
NPI:1619359338
Name:STORER, JESSICA LINIECE (NP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LINIECE
Last Name:STORER
Suffix:
Gender:F
Credentials:NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646
Mailing Address - Country:US
Mailing Address - Phone:828-737-7888
Mailing Address - Fax:828-737-7606
Practice Address - Street 1:436 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:828-737-7711
Practice Address - Fax:828-737-7713
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007700363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily