Provider Demographics
NPI:1821122565
Name:MYRICK, JANICE TILLERY (RN NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:TILLERY
Last Name:MYRICK
Suffix:
Gender:F
Credentials:RN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-0874
Mailing Address - Country:US
Mailing Address - Phone:252-586-4065
Mailing Address - Fax:
Practice Address - Street 1:19 NORTH DOBBS STREET
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:NC
Practice Address - Zip Code:27839-0010
Practice Address - Country:US
Practice Address - Phone:252-583-5021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC059484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily