Healthcare Provider Details

I. General information

NPI: 1922585256
Provider Name (Legal Business Name): JENNIFER KEY FOREMAN AGNP-C, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N FAYETTEVILLE ST STE A
ASHEBORO NC
27203-5573
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-3248
  • Fax: 336-625-6629
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5010761
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5010761
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: