Provider Demographics
NPI:1194349340
Name:FEATHERSTONE, JANNA KRISTEN
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:KRISTEN
Last Name:FEATHERSTONE
Suffix:
Gender:F
Credentials:
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 MARKET ST STE 110
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-9439
Practice Address - Country:US
Practice Address - Phone:704-384-9590
Practice Address - Fax:704-384-9591
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83122207Q00000X
NC2023-01192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine