MRS. JUSTINE KOERNER TYE CPNP NPI 1366724098

NPI Information

NPI: 1366724098
Provider Name: MRS. JUSTINE KOERNER TYE, CPNP
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

Address:
1350 S KINGS DR
CHARLOTTE, NC
ZIP 28207
Phone: (704) 446-1422
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MRS. Justine Koerner Tye, CPNP is a pediatrics nurse practitioner in Charlotte, NC. MRS. Justine Koerner Tye, CPNP NPI is 1366724098. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1350 S KINGS DR
CHARLOTTE, NC
ZIP 28207-134
Phone: (704) 446-1422
Fax: (704) 446-1582

The enumeration date for this NPI number is 9/20/2011 and was last updated on 1/3/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	5005317	NORTH CAROLINA	No
2	363LP0200X	Nurse Practitioner	Pediatrics	160512	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	NCF532A	MEDICARE PIN	NORTH CAROLINA
2	NP2580	MEDICAID	SOUTH CAROLINA
3	1366724098	MEDICAID	NORTH CAROLINA
4	1558308080	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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