Basic Information
Provider Information | |||||||||
NPI: | 1093143646 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LANIER | ||||||||
FirstName: | JESSICA | ||||||||
MiddleName: | HOLLAR | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5053 UNIT B EXECUTIVE DRIVE | ||||||||
Address2: |   | ||||||||
City: | MOREHEAD CITY | ||||||||
State: | NC | ||||||||
PostalCode: | 28557 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2527268480 | ||||||||
FaxNumber: | 2527268638 | ||||||||
Practice Location | |||||||||
Address1: | 1000 BRABHAM LN | ||||||||
Address2: |   | ||||||||
City: | JACKSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 285465003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9103413300 | ||||||||
FaxNumber: | 9102512067 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/17/2013 | ||||||||
LastUpdateDate: | 03/22/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5006550 | NC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 5006550 | NC | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.