Healthcare Provider Details

I. General information

NPI: 1699663708
Provider Name (Legal Business Name): JENNIFER LAURIA PIGFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MURCHISON RD
FAYETTEVILLE NC
28301-4298
US

IV. Provider business mailing address

103 CRESTVIEW RD
RALEIGH NC
27609-4408
US

V. Phone/Fax

Practice location:
  • Phone: 910-672-2892
  • Fax:
Mailing address:
  • Phone: 919-349-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number293131
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022501
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: