Healthcare Provider Details

I. General information

NPI: 1972043479
Provider Name (Legal Business Name): JESSICA JOYNER FIELDS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MATTHEWS TOWNSHIP PKWY STE 200
MATTHEWS NC
28105-5403
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-6901
  • Fax: 704-384-6902
Mailing address:
  • Phone: 704-384-6901
  • Fax: 704-384-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009302
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: