Healthcare Provider Details

I. General information

NPI: 1760779409
Provider Name (Legal Business Name): JESSICA WIKSTROM MCLAMB CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ROSE WIKSTROM CRNA

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7012 FIRES CREEK RD
HAYESVILLE NC
28904-7568
US

IV. Provider business mailing address

7012 FIRES CREEK RD
HAYESVILLE NC
28904-7568
US

V. Phone/Fax

Practice location:
  • Phone: 828-713-6793
  • Fax:
Mailing address:
  • Phone: 828-713-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number210079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: