Provider Demographics
NPI:1962730960
Name:JESSUP, JENNIFER BENFIELD (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BENFIELD
Last Name:JESSUP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KRISTEN
Other - Last Name:BENFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2892
Mailing Address - Country:US
Mailing Address - Phone:252-752-4124
Mailing Address - Fax:252-752-0449
Practice Address - Street 1:3311 TRENT RD
Practice Address - Street 2:
Practice Address - City:TRENT WOODS
Practice Address - State:NC
Practice Address - Zip Code:28562-5704
Practice Address - Country:US
Practice Address - Phone:252-634-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762180Medicare PIN