Provider Demographics
NPI:1316318660
Name:CUMMINS, JESSICA RAE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HAWTHORNE LN STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2536
Mailing Address - Country:US
Mailing Address - Phone:704-372-5180
Mailing Address - Fax:704-376-6280
Practice Address - Street 1:201 QUEENS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3217
Practice Address - Country:US
Practice Address - Phone:704-372-5180
Practice Address - Fax:704-376-6280
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily