Healthcare Provider Details

I. General information

NPI: 1891237178
Provider Name (Legal Business Name): JEANINE ANNE CUNNINGHAM DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 10/02/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WESTRIDGE MARKET PL
CANDLER NC
28715-9174
US

IV. Provider business mailing address

25 WESTRIDGE MARKET PL
CANDLER NC
28715-9174
US

V. Phone/Fax

Practice location:
  • Phone: 828-418-0040
  • Fax:
Mailing address:
  • Phone: 828-418-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009508
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: