Healthcare Provider Details

I. General information

NPI: 1154865251
Provider Name (Legal Business Name): KATASHA JARRIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATASHA JARRIN FNP

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 06/13/2024
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 RAEFORD RD STE A
FAYETTEVILLE NC
28305-5483
US

IV. Provider business mailing address

2529 RAEFORD RD STE A
FAYETTEVILLE NC
28305-5483
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-7097
  • Fax:
Mailing address:
  • Phone: 910-703-7097
  • Fax: 910-637-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009144
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5009144
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: