MEDICARE: JESSICA CHANDLER HALL FNP

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	363LF0000X	Family Nurse Practitioner	5024294	NC

General Provider Information

NPI Number	:	1891632956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CHANDLER HALL FNP

Provider Business Mailing Address
First Line	:	4839 BREDEN ST
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-6440
Country	:	US
Telephone Number	:	919-260-0852
Fax Number	:	919-260-0852

Provider Business Practice Location Address
First Line	:	9908 COULOAK DR STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8678
Country	:	US
Telephone Number	:	704-801-5140
Fax Number	:	919-260-0852

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

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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