Provider Demographics
NPI:1215561097
Name:JERBY, SUSAN HEATHER (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HEATHER
Last Name:JERBY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6727
Mailing Address - Country:US
Mailing Address - Phone:980-339-5155
Mailing Address - Fax:980-216-8522
Practice Address - Street 1:3049 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6727
Practice Address - Country:US
Practice Address - Phone:980-339-5155
Practice Address - Fax:980-216-8522
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner