Healthcare Provider Details

I. General information

NPI: 1154244135
Provider Name (Legal Business Name): JESSICA FORTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 CROWN CRESCENT CT APT 1512
CHARLOTTE NC
28227-6793
US

IV. Provider business mailing address

620 N CHURCH ST APT 1512
CHARLOTTE NC
28202-3298
US

V. Phone/Fax

Practice location:
  • Phone: 980-944-8895
  • Fax:
Mailing address:
  • Phone: 240-439-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: