Healthcare Provider Details

I. General information

NPI: 1700059060
Provider Name (Legal Business Name): JENNIFER WHISNANT CHURCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PINE MOUNTAIN RD STE 2
HUDSON NC
28638-2600
US

IV. Provider business mailing address

321 MULBERRY STREET, SW MEDICAL STAFF SERVICES
LENOIR NC
28645
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-6330
  • Fax: 828-757-6349
Mailing address:
  • Phone: 828-757-5965
  • Fax: 828-757-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5003956
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: