Provider Demographics
NPI:1013122092
Name:JUSTICE, JOY LIANNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:LIANNE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:FNP
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 604042
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4042
Mailing Address - Country:US
Mailing Address - Phone:704-316-4136
Mailing Address - Fax:704-417-4814
Practice Address - Street 1:2085 FRONTIS PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5614
Practice Address - Country:US
Practice Address - Phone:704-316-4136
Practice Address - Fax:704-417-4814
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5001921363L00000X, 363L00000X
NC21971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006048Medicaid
NC2594187Medicare PIN