Healthcare Provider Details

I. General information

NPI: 1770418378
Provider Name (Legal Business Name): JENNA RADFORD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 TALKING ROCK DR APT 2134
CARY NC
27519-1863
US

IV. Provider business mailing address

2100 TALKING ROCK DR APT 2134
CARY NC
27519-1863
US

V. Phone/Fax

Practice location:
  • Phone: 919-482-0624
  • Fax:
Mailing address:
  • Phone: 919-482-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026019969
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: