Healthcare Provider Details

I. General information

NPI: 1316980915
Provider Name (Legal Business Name): JENNIFER E. MERSEREAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER E. JACKSON M.D.

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/20/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KEISLER DR STE 102
CARY NC
27518-7083
US

IV. Provider business mailing address

300 KEISLER DR STE 102
CARY NC
27518-7083
US

V. Phone/Fax

Practice location:
  • Phone: 984-464-2244
  • Fax: 984-464-3160
Mailing address:
  • Phone: 984-464-2244
  • Fax: 984-464-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-107405
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA85943
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2007-00448
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: