Healthcare Provider Details

I. General information

NPI: 1649515594
Provider Name (Legal Business Name): JILLIAN PHIPPS REED ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN M PHIPPS

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 04/14/2022
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD MEDICAL CENTER PLAZA, SUITE 200
CHARLOTTE NC
28203-5865
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-8840
  • Fax: 704-381-8848
Mailing address:
  • Phone: 704-381-8840
  • Fax: 704-381-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberARNP9293625
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number270215
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5006976
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: