Healthcare Provider Details

I. General information

NPI: 1669871182
Provider Name (Legal Business Name): JENNIFER L. GIVENS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 NC HIGHWAY 50
MAPLE HILL NC
28454-8153
US

IV. Provider business mailing address

301 S CAMPBELL ST
BURGAW NC
28425-5011
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-6444
  • Fax: 910-259-6659
Mailing address:
  • Phone: 910-259-6973
  • Fax: 910-259-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22190
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: