MEDICARE: JESSICA MARIE MCCARTHY C.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	24171050501	MI

General Provider Information

NPI Number	:	1144550922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE MCCARTHY C.R.N.P.

Provider Business Mailing Address
First Line	:	1209 CEDARHILL DR
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1287
Country	:	US
Telephone Number	:	267-994-0021
Fax Number	:

Provider Business Practice Location Address
First Line	:	15125 22 MILE RD
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48315-4406
Country	:	US
Telephone Number	:	586-532-0599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2009
Last Update Date	:	12/02/2025

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