Provider Demographics
NPI:1487260451
Name:INMAN-PUCKETT, JO ELLEN (DNP, AGPCNP)
Entity type:Individual
Prefix:DR
First Name:JO
Middle Name:ELLEN
Last Name:INMAN-PUCKETT
Suffix:
Gender:F
Credentials:DNP, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7264
Mailing Address - Country:US
Mailing Address - Phone:704-948-6169
Mailing Address - Fax:
Practice Address - Street 1:31 SWISS PINE CT
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8704
Practice Address - Country:US
Practice Address - Phone:828-765-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013551363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health