Healthcare Provider Details

I. General information

NPI: 1558192039
Provider Name (Legal Business Name): JESSICA RENEE SHEPHERD NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RENEE NOWICK NNP

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONE HEALTH WOMEN'S AND CHILDREN'S CENTER 1200 N ELM STREET, ENTRANCE C
GREENSBORO NC
27401
US

IV. Provider business mailing address

813 CLEVELAND ST
DURHAM NC
27701-2431
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-6561
  • Fax:
Mailing address:
  • Phone: 919-610-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5020548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: