Healthcare Provider Details

I. General information

NPI: 1295797108
Provider Name (Legal Business Name): JENNIFER JONES WHITLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 NC HIGHWAY 242 N
BENSON NC
27504-7844
US

IV. Provider business mailing address

725 POLLARD RD
SMITHFIELD NC
27577-9084
US

V. Phone/Fax

Practice location:
  • Phone: 919-894-2911
  • Fax:
Mailing address:
  • Phone: 919-989-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201765
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: