Healthcare Provider Details

I. General information

NPI: 1437795416
Provider Name (Legal Business Name): JESSICA DAWN BREAUX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

695 OAK STUMP RD
ELIZABETH CITY NC
27909-7605
US

V. Phone/Fax

Practice location:
  • Phone: 919-457-1517
  • Fax: 919-363-7697
Mailing address:
  • Phone: 252-331-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: