Healthcare Provider Details

I. General information

NPI: 1396385167
Provider Name (Legal Business Name): JESSICA L PRITCHARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 BALLANTYNE MEDICAL PL STE 240
CHARLOTTE NC
28277-4790
US

IV. Provider business mailing address

4501 SOMERDALE LN
CHARLOTTE NC
28205-4651
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-5245
  • Fax:
Mailing address:
  • Phone: 704-813-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number259224
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: