Provider Demographics
NPI:1306481809
Name:NULL, JESSICA NICOLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:NULL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1490
Mailing Address - Country:US
Mailing Address - Phone:828-262-3886
Mailing Address - Fax:828-265-4816
Practice Address - Street 1:240 HIGHWAY 105 EXT STE 100
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4291
Practice Address - Country:US
Practice Address - Phone:828-264-7311
Practice Address - Fax:828-264-7907
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily