Healthcare Provider Details

I. General information

NPI: 1295314102
Provider Name (Legal Business Name): JENNIFER REACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

1032 N SANDHILL RD
LENA MS
39094-9318
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-5490
  • Fax:
Mailing address:
  • Phone: 601-519-8369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5014259
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5014259
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: