Healthcare Provider Details

I. General information

NPI: 1649761230
Provider Name (Legal Business Name): JEANNA MARIE ASHMAN STOVER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2018
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TILGHMAN DR
DUNN NC
28334-5510
US

IV. Provider business mailing address

800 TILGHMAN DRIVE PO BOX 1706
DUNN NC
28335
US

V. Phone/Fax

Practice location:
  • Phone: 919-892-1000
  • Fax:
Mailing address:
  • Phone: 910-892-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2021-03302
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021-03302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: