Provider Demographics
NPI:1528719747
Name:MCCAIN, JESSICA MARGIE LEE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARGIE LEE
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4317
Mailing Address - Country:US
Mailing Address - Phone:704-874-3300
Mailing Address - Fax:
Practice Address - Street 1:101 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2319
Practice Address - Country:US
Practice Address - Phone:864-489-1446
Practice Address - Fax:864-489-4909
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily