Provider Demographics
NPI:1730334145
Name:MAY, JENNIFER TETTERTON (ANP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TETTERTON
Last Name:MAY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2817
Mailing Address - Country:US
Mailing Address - Phone:912-602-0083
Mailing Address - Fax:
Practice Address - Street 1:721 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2817
Practice Address - Country:US
Practice Address - Phone:912-602-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004195363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health