Healthcare Provider Details

I. General information

NPI: 1669256707
Provider Name (Legal Business Name): JENNIFER ANN RESICK MSN APRN FNPC CCMCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CABARRUS AVE E
CONCORD NC
28025-3699
US

IV. Provider business mailing address

9141 WARREN RD
KERNERSVILLE NC
27284-9803
US

V. Phone/Fax

Practice location:
  • Phone: 855-743-2274
  • Fax: 855-857-7333
Mailing address:
  • Phone: 814-381-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number5023134
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: