Healthcare Provider Details

I. General information

NPI: 1114937224
Provider Name (Legal Business Name): JESSICA PITTS CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEIGH PITTS NP

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DOLLEY MADISON RD STE 410
GREENSBORO NC
27410-5167
US

IV. Provider business mailing address

445 DOLLEY MADISON RD STE 410
GREENSBORO NC
27410-5167
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-1510
  • Fax: 336-292-0679
Mailing address:
  • Phone: 336-292-1510
  • Fax: 336-292-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN188186
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5001453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: