Provider Demographics
NPI:1386913119
Name:SPARROW, JESSICA GRANTHAM (DNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:GRANTHAM
Last Name:SPARROW
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 DRESSER CT STE 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7325
Mailing Address - Country:US
Mailing Address - Phone:919-618-3046
Mailing Address - Fax:919-375-3972
Practice Address - Street 1:1004 DRESSER CT STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7325
Practice Address - Country:US
Practice Address - Phone:919-618-3046
Practice Address - Fax:919-375-3972
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208767101YM0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health