Healthcare Provider Details

I. General information

NPI: 1811475981
Provider Name (Legal Business Name): JESSICA HUDSON YELVERTON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

4307 DIXON RD
GRIMESLAND NC
27837-8938
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4380
  • Fax:
Mailing address:
  • Phone: 252-531-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5010801
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: