Provider Demographics
NPI:1841923430
Name:JESSUP, T'ERRAH NICOLE (MPH, IBCLC)
Entity type:Individual
Prefix:
First Name:T'ERRAH
Middle Name:NICOLE
Last Name:JESSUP
Suffix:
Gender:F
Credentials:MPH, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MERRELL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-3819
Mailing Address - Country:US
Mailing Address - Phone:336-997-5896
Mailing Address - Fax:
Practice Address - Street 1:4000 OSSI CT STE 257
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8827
Practice Address - Country:US
Practice Address - Phone:336-536-6466
Practice Address - Fax:336-819-5518
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
NCL-301178174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator