Healthcare Provider Details

I. General information

NPI: 1891632956
Provider Name (Legal Business Name): JESSICA CHANDLER HALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 COULOAK DR STE 201
CHARLOTTE NC
28216-8678
US

IV. Provider business mailing address

4839 BREDEN ST
KANNAPOLIS NC
28081-6440
US

V. Phone/Fax

Practice location:
  • Phone: 704-801-5140
  • Fax: 919-260-0852
Mailing address:
  • Phone: 919-260-0852
  • Fax: 919-260-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: